Recurrent cisplatin hypersensitivity reaction after first exposure: A case report

Area of Science:

• Oncology
• Clinical Immunology
• Pharmacology

Background:

• Hypersensitivity reactions to platinum-based chemotherapy are common and can limit treatment efficacy for various cancers.
• Allergy skin testing is a method used to assess the safety of re-administering platinum-based chemotherapy.
• Cisplatin is a widely used platinum-based chemotherapy agent.

Observation:

• A 64-year-old male with stage IVa hypopharyngeal squamous cell carcinoma experienced delayed facial swelling and dysphagia after a single dose of cisplatin.
• Initial allergy skin testing for cisplatin hypersensitivity yielded a negative result.
• Upon receiving a second dose of cisplatin, the patient exhibited an immediate hypersensitivity reaction.

Findings:

• This case presents an atypical manifestation of cisplatin hypersensitivity, occurring after the initial dose in a patient with no prior platinum exposure.
• The allergy skin test demonstrated limited efficacy, producing a false negative result.
• Cisplatin administration was ceased, and the patient was switched to cetuximab for treatment completion.

Implications:

• Skin allergy testing has limited sensitivity for detecting hypersensitivity to platinum-based chemotherapy, necessitating careful consideration of risks versus benefits for re-exposure.
• Clinicians should be aware that cisplatin hypersensitivity, though rare, can manifest even after the first exposure.
• This case underscores the need for vigilance and alternative strategies when managing potential hypersensitivity reactions to chemotherapy.