HYPERSENSITIVITY REACTIONS TO PLATINUMS: SYSTEMATIC REVIEW OF EFFICACY AND SAFETY OF DESENSITIZATION

Abstract

Introduction

Platinum compounds are associated with a high incidence of hypersensitivity reactions (HSR) and IgE sensitization occurs after multiple exposures, leading to allergic symptoms and anaphylaxis. Drug desensitization induces a temporary immunological tolerance, permitting safe re-administration of platinums in allergic individuals.

Methods

To assess the safety and efficacy of rapid drug desensitization (RDD) for platinum hypersensitivity reactions we underwent a systematic review. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered the study in PROSPERO(CRD42023473211). The comprehensive search was conducted in Medline, Embase, Web of Science and Scopus databases.

Results

A total of 53 studies were included (n=2853 cases) from 11 countries between 1998-2024 of patients with initial HSR to platinums, carboplatin (n=44), oxaliplatin (n=30) and cisplatin (n=23) that underwent desensitization. The most frequent symptoms of HSR to platinum were skin and respiratory. There was variability in the type of desensitization protocols used, the most frequent being 4 bags-4 steps and 3-4 bags and 12-16 steps, with an average duration of 2.5-5.7 hours. Premedication was reported in most cases (n=49). Patients tolerated the desensitization protocol; the success rate at desensitization with carboplatin and oxaliplatin varied between 67-100%, while it was 100% in all cases of desensitization for cisplatin. An incidence of HSR during desensitization was reported, ranging from 4.4% to 96.7% (median of 24%), and no associated deaths.

Conclusion

RDD is a safe and effective procedure in patients with platinum HSR, helping to improve quality of life and safely providing treatment with first line therapy.