title: A digestive allergic reaction with hypereosinophilia imputable to docetaxel in a breast cancer patient: a case report.
abstract: BACKGROUND
  Hypereosinophilia, defined by an absolute eosinophil count of more than 1500/mm3, is rarely observed in patients treated for cancer, and rarely imputable to anti-cancer agents. Drug-induced hypereosinophilia usually appears within a few weeks of the start of treatment and resolves after discontinuation of the medication. We report here a first case of hypereosinophilia with digestive allergic reaction imputable to docetaxel in a woman treated for breast cancer.
  
  
  METHODS
  This patient, with a history of childhood atopic dermatitis and asthma, underwent surgery for breast lobular carcinoma, followed with chemotherapy including 3 cycles of the FEC100 protocol and 3 cycles of docetaxel. Ten days after the second cycle of docetaxel, she had abdominal pain with diarrhea, which increased after the third cycle of docetaxel at the same dose. The blood eosinophil count increased up to 4685/mm(3) at day 92. All biological tests were normal, except elevated seric IgE. The systematic biopsies of the upper and lower digestive tract showed diffuse edema of the lamina propria, lymphocytic infiltrate and CD117-expressing cells both in the epithelium and in the lamina propria. Electron microscopy showed a large number of degranulating mast cells, while the number of tissue eosinophils was small. The blood eosinophil count decreased after day 96, three months after the last injection of docetaxel. After day 182, the hypereosinophilia and symptoms resolved. This spontaneous evolution, the history of atopic dermatitis and asthma, and the negativity of all biological tests performed led us to hypothesize a diagnosis of a systemic digestive Type 1 drug-induced hypersensitivity reaction. Using two validated pharmacovigilance scales, we found that docetaxel had the highest imputability score compared to the other drugs.
  
  
  CONCLUSIONS
  Recognition of allergic reactions imputable to docetaxel is important because it requires the drug to be discontinued. In the difficult setting of anti-cancer treatment, if reintroduction of the drug is needed, a close collaboration between oncologists, gastroenterologists and allergologists is required.
authors.affiliation: Centre Hospitalier de Marne-la-Vallée, Service d'Oncologie Médicale, Jossigny, F-77600, France. diaddin_h@hotmail.com.|U1165, Université Paris7, Inserm, Hôpital Saint-Louis, Paris, F-75010, France. diaddin_h@hotmail.com.
authors.forename: Diaddin
authors.initials: D
authors.lastname: Hamdan
authors.affiliation: U1165, Université Paris7, Inserm, Hôpital Saint-Louis, Paris, F-75010, France. christophe.leboeuf@gmail.com.|Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Pathologie, UMR-S 1165, F-75010, Paris, France. christophe.leboeuf@gmail.com.
authors.forename: Christophe
authors.initials: C
authors.lastname: Leboeuf
authors.affiliation: AP-HP-Hôpital Saint-Louis, Laboratoire de Pathologie, Paris, F-75010, France. cathy.pereira@aphp.fr.
authors.forename: Cathy
authors.initials: C
authors.lastname: Pereira
authors.affiliation: AP-HP-Hôpital Saint-Louis, Pharmacie, Paris, F-75010, France. nathalie.jourdan@aphp.fr.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Jourdan
authors.affiliation: U1165, Université Paris7, Inserm, Hôpital Saint-Louis, Paris, F-75010, France. laurence.verneuil@gmail.com.|Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Pathologie, UMR-S 1165, F-75010, Paris, France. laurence.verneuil@gmail.com.|Université de Caen Basse-Normandie, Medical School, Caen, F-14000, France. laurence.verneuil@gmail.com.
authors.forename: Laurence
authors.initials: L
authors.lastname: Verneuil
authors.affiliation: U1165, Université Paris7, Inserm, Hôpital Saint-Louis, Paris, F-75010, France. guilhem.bousquet@aphp.fr.|Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Pathologie, UMR-S 1165, F-75010, Paris, France. guilhem.bousquet@aphp.fr.|AP-HP-Hôpital Avicenne, Service d'Oncologie Médicale, Bobigny, F-93008, France. guilhem.bousquet@aphp.fr.|Université Paris 13, Leonard de Vinci, Villetaneuse, F-93430, France. guilhem.bousquet@aphp.fr.|U1165, 1 avenue Vellefaux, Paris, F-75010, France. guilhem.bousquet@aphp.fr.
authors.forename: Guilhem
authors.initials: G
authors.lastname: Bousquet
authors.affiliation: U1165, Université Paris7, Inserm, Hôpital Saint-Louis, Paris, F-75010, France. anne.janin1165@gmail.com.|Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Pathologie, UMR-S 1165, F-75010, Paris, France. anne.janin1165@gmail.com.|AP-HP-Hôpital Saint-Louis, Laboratoire de Pathologie, Paris, F-75010, France. anne.janin1165@gmail.com.
authors.forename: Anne
authors.initials: A
authors.lastname: Janin
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy; D000077143:Docetaxel; D004342:Drug Hypersensitivity / Q000473:pathology; D004802:Eosinophilia / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D041981:Gastrointestinal Tract / Q000187:drug effects / Q000473:pathology*; D006801:Humans; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000970:Antineoplastic Agents; D043823:Taxoids; D000077143:Docetaxel
references.citation: Curr Opin Hematol. 2014 Jan;21(1):3-7
references.pmid: 24322486
references.citation: Clin Rev Allergy Immunol. 2015 Oct;49(2):177-91
references.pmid: 24740483
references.citation: J Exp Med. 1995 Dec 1;182(6):1897-904
references.pmid: 7500035
references.citation: Clin Biochem Rev. 2013 Feb;34(1):15-38
references.pmid: 23592889
references.citation: J Allergy Clin Immunol. 2012 Sep;130(3):607-612.e9
references.pmid: 22460074
references.citation: J Allergy Clin Immunol. 2010 May;125(5):1046-1053.e8
references.pmid: 20451039
references.citation: Blood. 1994 May 15;83(10):2759-79
references.pmid: 8180373
references.citation: Asia Pac Allergy. 2015 Apr;5(2):123-7
references.pmid: 25938077
references.citation: J Exp Clin Cancer Res. 2011;30:93
references.pmid: 21970649
references.citation: Gastroenterology. 1996 Mar;110(3):768-74
references.pmid: 8608886
references.citation: J Natl Cancer Inst. 1992 Dec 2;84(23):1781-8
references.pmid: 1359154
references.citation: Immunol Allergy Clin North Am. 2007 Aug;27(3):529-49
references.pmid: 17868863