Cross-reactivity between paclitaxel and hazelnut: a case report

Area of Science:

• Oncology
• Allergy and Immunology
• Pharmacology

Background:

• Metastatic bladder cancer treatment often involves chemotherapy agents like paclitaxel.
• Hypersensitivity reactions to chemotherapy can occur, necessitating prompt management.
• Patient history of allergies is crucial for predicting and managing adverse drug events.

Observation:

• A 73-year-old female patient with metastatic bladder cancer developed acute hypersensitivity symptoms during paclitaxel infusion.
• Symptoms included hives, pruritus, dyspnea, and malaise, resolving upon drug discontinuation and treatment with antihistamines and corticosteroids.
• The patient reported a similar reaction history to hazelnuts, prompting further investigation.

Findings:

• A literature search revealed paclitaxel components are present in hazelnut trees and nuts.
• The patient's reaction suggests a potential cross-reactivity between paclitaxel and hazelnut components, rather than a typical nut-protein allergy.
• This challenges the assumption that the patient's hazelnut reaction was solely due to nut proteins.

Implications:

• Patients with a reported hazelnut allergy require vigilant observation during paclitaxel administration.
• The findings highlight the possibility of a paclitaxel-component allergy masquerading as a hazelnut allergy.
• This necessitates a re-evaluation of allergy assessments in patients undergoing paclitaxel therapy.