A single center experience in the management of suspected hypersensitivity reactions to chemotherapy

Background. Hypersensitivity reactions to chemotherapy are increasing, thus there is a need to implement a correct diagnostic pathway to avoid switch to second line therapies or unnecessary drug desensitization. The objective of the study was to evaluate our experience in the management of immediate reactions to chemotherapy, focusing on the role of drug provocation test. Methods. Observational longitudinal study, where the allergological work-up included: patient's clinical history, characteristics of the reaction comprehensive of its phenotype ("type 1", "CRR", "either", "mixed"), skin testing (ST) and drug provocation test (DPT), when the risk assessment was favorable. The work-up was considered positive if ST or DPT resulted positive. Results. 162 patients were enrolled and most of them were delabled (98/162, 60.5%). The probability of delabeling was higher when the reaction involved taxanes (p<0.005), occured during the first drug exposure (p<0.05) and presented with "CRR" phenotype (p<0.005). The work-up was considered positive in 53 patients (32.7%) and they were mainly patients who reinitiated treatment after a gap (p=0.001) and experienced "type 1" reactions (p<0.05). Conclusions. The thorough evaluation has allowed us to identify different subsets of patients requiring different managing approaches. Furthermore, we confirmed the need and safety of implementing drug provocation test.