Hypersensitivity reactions to chemotherapy: an EAACI Position Paper

Area of Science:

• Oncology
• Allergy and Immunology
• Pharmacology

Background:

• Chemotherapeutic agents have been used for cancer treatment for decades, often in combination therapies.
• Hypersensitivity reactions (HSRs) to chemotherapy drugs are a significant clinical concern, representing a leading cause of fatal drug-induced anaphylaxis.
• Reactions are frequently associated with platinum compounds, taxanes, epipodophyllotoxins, and asparaginase, with considerable variation in incidence and management strategies across institutions.

Purpose of the Study:

• To establish consensus on the allergological work-up for hypersensitivity reactions to chemotherapeutic drugs.
• To provide practical recommendations for clinicians managing patients experiencing HSRs to chemotherapy.
• To address the heterogeneity in diagnosis, treatment, and prevention of these reactions.

Main Methods:

• A task force organized by the European Network on Drug Allergy and the Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology.
• Development of a position paper based on expert discussion and review of current practices.
• Inclusion of key sections on risk factors, pathogenesis, symptoms, diagnostic tests (skin, in vitro, provocation), and desensitization.

Main Results:

• Identification of key chemotherapeutic agents associated with HSRs.
• Discussion of diagnostic modalities including skin tests, in vitro assays, and drug provocation tests.
• Recommendations for the management, including desensitization, of hypersensitivity reactions in cancer patients.

Conclusions:

• There is a need for standardized approaches to the diagnosis and management of chemotherapy-induced hypersensitivity reactions.
• The paper provides a framework for clinicians to improve patient care and safety.
• Further research is needed to address unmet needs in understanding and managing HSRs to chemotherapeutic agents.