Value of Skin Tests for Managing Hypersensitivity Reactions to Platinum Salts

Abstract Background: Platinum-based therapy continues to be one of the pillars of the treatment of different types of cancer. However, many times the responsible clinician renounces its use after the appearance of a hypersensitivity reaction.Objective: To assess the value of skin tests (ST) in clinical practice to address the treatment of patients with suspicion of immediate hypersensitivity reactions (HSRs) to platinum salts.Methods: Single-center retrospective study performed for 3 years. Adult patients treated with any platinum salt who experienced HSR symptoms and for whom an oncologist requested ST, were included. ST with cisplatin, carboplatin and oxaliplatin were performed. Results: Twenty-two patients were included. ST were positive in 12 patients (54.5%), of which 4 (33%) presented cross-reactivity to another platinum salt. Fifteen patients continued platinum-based chemotherapy: 9 patients with positive ST (4 continued by desensitization and 5 with another platinum) and 6 patients with negative ST, of which 1 repeated an HSR. A NPV of 0.91 was calculated. Conclusion: ST allowed accurate identification of platinum allergy patients and the resumption of platinum-based therapy in many patients for whom no suitable therapeutic alternative was clinically acceptable.

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In Vivo Cysteinyl Leukotriene Release in Allergic and Nonallergic Immediate Hypersensitivity Reactions during Anesthesia

Anesthesiology ◽

10.1097/aln.0000000000001600 ◽

2017 ◽

Vol 126 (5) ◽

pp. 834-841 ◽

Cited By ~ 2

Author(s):

Dominique Laroche ◽

Pierre Léturgie ◽

Delphine Mariotte ◽

Yann Ollivier ◽

Jean-Luc Hanouz ◽

...

Keyword(s):

Mast Cell ◽

Skin Tests ◽

Hypersensitivity Reactions ◽

Immediate Hypersensitivity ◽

Mast Cell Tryptase ◽

Cysteinyl Leukotriene ◽

Negative Results ◽

Important Mediator ◽

The Difference

Abstract Background Immediate hypersensitivity reactions occurring during anesthesia are classified as allergic when skin tests and mast cell tryptase are positive and as nonallergic when negative results are obtained. Cysteinyl leukotrienes (cysLTs) are potent mediators synthesized by mast cell and eosinophil that induce bronchial constriction. They could play a role in hypersensitivity reactions. Methods cysLT C4, D4, and E4 concentrations were measured by a competition immunoassay in serial plasma samples obtained prospectively from 21 anesthetized controls and retrospectively from 34 patients who reacted at induction of anesthesia (24 with allergic and 10 with nonallergic reactions). Results In controls, the median (interquartile range) cysLT concentration was 0.83 (0.69 to 1.02) μg/l before anesthesia and was unchanged 30 min, 6 h, and 24 h afterward. In the patients with allergic reactions, the values were highly increased 30 to 60 min after the reaction (17.9 [7.8 to 36.0] μg/l), while the patients with nonallergic reactions had less increased values (7.3 [3.0 to 11.5] μg/l). The difference between the three groups was significant (P < 0.0001). Increased values persisted during the 24 h of observation. Concentrations were significantly higher in patients with bronchospasm (P = 0.016). Conclusions cysLTs appear to be an important mediator of allergic and nonallergic immediate hypersensitivity reactions. These findings might open a new field for management of patients with hypersensitivity reactions, especially nonallergic ones.

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Hypersensitivity reactions to low molecular weight heparins: different patterns of cross-reactivity in 3 patients

Canadian Journal of Physiology and Pharmacology ◽

10.1139/cjpp-2017-0246 ◽

2018 ◽

Vol 96 (4) ◽

pp. 428-432 ◽

Cited By ~ 1

Author(s):

Danica Juricic Nahal ◽

Ivana Cegec ◽

Viktorija Erdeljic Turk ◽

Ksenija Makar Ausperger ◽

Iva Kraljickovic ◽

...

Keyword(s):

Molecular Weight ◽

Challenge Test ◽

Cross Reactivity ◽

Skin Tests ◽

Delayed Type Hypersensitivity ◽

Low Molecular Weight ◽

Hypersensitivity Reactions ◽

Low Molecular Weight Heparins ◽

Safe Alternative ◽

Delayed Reactions

Low molecular weight heparins (LMWHs) are used for a variety of indications. The most common type of hypersensitivity reactions to LMWHs are delayed-type hypersensitivity reactions (DHR). Immediate-type hypersensitivity reactions (IHR) occur only sporadically. Cross-reactivity of different LMWHs is a common and unpredictable problem. We present 2 cases of patients who developed DHR to nadroparin and enoxaparin, respectively. The third case presents a patient who developed IHR to nadroparin. Skin tests confirmed the hypersensitivity in all cases. In the cases of DHR, a skin test negative LMWH was identified and was tolerated in a challenge test. In the IHR case, cross-reactivity to all tested LMWHs was established. We hypothesize that the degree of cross-reactivity might depend on the type of hypersensitivity reaction with immediate reactions linked to more extensive cross-reactivity than delayed reactions. This is important to consider because, at least in some cases, a safe alternative LMWH can be identified.

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Converter Phenotype: A New Profile That Is Not Exclusive to Taxanes

Frontiers in Allergy ◽

10.3389/falgy.2021.785259 ◽

2022 ◽

Vol 2 ◽

Author(s):

Teodorikez Wilfox Jimenez-Rodriguez ◽

Francisco Manuel Marco de la Calle ◽

Inmaculada Lozano-Cubo ◽

Rosa Ana Montoyo-Anton ◽

Victor Soriano-Gomis ◽

...

Keyword(s):

Clinical Characteristics ◽

Drug Exposure ◽

Drug Hypersensitivity ◽

Skin Tests ◽

Hypersensitivity Reactions ◽

Test Results ◽

Drug Reactions ◽

Immediate Hypersensitivity ◽

Drug Hypersensitivity Reactions ◽

Median Interval

Introduction: Phenotype I hypersensitivity reactions are the most commonly reported drug reactions; however, precision medicine has made it possible to characterize new phenotypes. A recent communication proposed the existence of a “converter phenotype,” which would affect patients who present non-immediate hypersensitivity reactions and in subsequent exposures develop immediate hypersensitivity reactions. This study aimed to describe the clinical characteristics of converter phenotype reactions and their evolution during desensitization to chemotherapeutic drugs and monoclonal antibodies.Methods: We retrospectively reviewed our database of patients undergoing desensitization to chemotherapy or biological agents and selected those with a converter phenotype. Demographic and clinical characteristics of the patients, the results of skin tests, tryptase and IL-6 levels, and desensitization outcomes were assessed.Results: Of 116 patients evaluated, 12 (10.3%) were identified as having a converter phenotype. The median interval between drug exposure and reaction was 90.6 h (range 8-288 h). After the conversion, phenotype I was the most frequent (58.3%), followed by cytokine release reactions (33.3%). Fifty-one desensitizations were undertaken and all treatments completed, with 10 (19.6%) breakthrough reactions. No new changes in the phenotype were detected.Conclusions: The symptoms of non-immediate drug hypersensitivity reactions may indicate the need for an early allergological evaluation to assess the risk of future immediate drug reactions. Clinical characteristics, skin test results, and biomarkers can help predict responses to rapid drug desensitization, guiding clinicians on how to optimize therapy delivery while maintaining patient safety.

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Evaluation of a New Routine Diagnostic Test for Immunoglobulin E Sensitization to Neuromuscular Blocking Agents

Anesthesiology ◽

10.1097/aln.0b013e31820164d2 ◽

2011 ◽

Vol 114 (1) ◽

pp. 91-97 ◽

Cited By ~ 52

Author(s):

Dominique Laroche ◽

Sylvie Chollet-Martin ◽

Pierre Léturgie ◽

Laure Malzac ◽

Marie-Claude Vergnaud ◽

...

Keyword(s):

Skin Test ◽

Quaternary Ammonium ◽

Immunoglobulin E ◽

Solid Phase ◽

Specific Ige ◽

Neuromuscular Blocking ◽

Neuromuscular Blocking Agents ◽

Skin Tests ◽

Hypersensitivity Reactions ◽

Immediate Hypersensitivity

Background Neuromuscular blocking agents (NMBA) are responsible for most immediate hypersensitivity reactions during anesthesia, as a result of the presence of a quaternary ammonium ion. The aim of this study was to evaluate the diagnostic performance of a commercial immunoglobulin E (IgE) test (quaternary ammonium morphine [QAM]) for diagnosing sensitivity to NMBA. Methods We tested 168 patients exposed to NMBAs during anesthesia. Of those patients, 54 had an uneventful procedure and 114 had immediate hypersensitivity reactions, and 57 patients had positive skin tests to the administered NMBA, whereas 57 had negative skin tests. Specific IgE concentrations determined with the QAM method based on a morphine solid phase were compared with those obtained with a recommended experimental method with a choline solid phase. Results For the QAM test, a 0.35 kUA/l positivity cutoff was chosen from the receiver operating characteristics curve. QAM-specific IgE was found in 84.2% of skin test-positive reactors (80.7% with the recommended method; no significant difference), and binding was inhibited by the culprit NMBA in 80% of cases. The frequency of QAM-specific IgE positivity was significantly higher in skin test-negative reactors (24.6%) than in controls (9.3%), suggesting NMBA sensitivity. Conclusion Sensitivity of the QAM test (84.2%), together with its simplicity and suitability for routine laboratory use, makes it a valuable tool, in conjunction with skin tests, for diagnosing NMBA sensitivity in patients who react after NMBA injection. The QAM test is of particular interest when skin tests are not available or not reliable or give results poorly compatible with mediator release or clinical features.

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Immediate-type hypersensitivity reactions to proton pump inhibitors: usefulness of skin tests in the diagnosis and assessment of cross-reactivity

Allergy ◽

10.1111/all.12189 ◽

2013 ◽

Vol 68 (8) ◽

pp. 1008-1014 ◽

Cited By ~ 19

Author(s):

S. Kepil Özdemir ◽

İ. Yılmaz ◽

Ö. Aydın ◽

S. Büyüköztürk ◽

A. Gelincik ◽

...

Keyword(s):

Proton Pump Inhibitors ◽

Proton Pump ◽

Cross Reactivity ◽

Skin Tests ◽

Hypersensitivity Reactions

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IgE antibodies and skin tests in immediate hypersensitivity reactions to infliximab in inflammatory bowel disease

European Journal of Gastroenterology & Hepatology ◽

10.1097/meg.0000000000000436 ◽

2015 ◽

Vol 27 (10) ◽

pp. 1200-1208 ◽

Cited By ~ 11

Author(s):

Estelle Fréling ◽

Laurent Peyrin-Biroulet ◽

Claire Poreaux ◽

Alain Morali ◽

Julie Waton ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Skin Tests ◽

Hypersensitivity Reactions ◽

Immediate Hypersensitivity ◽

Ige Antibodies ◽

Inflammatory Bowel

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Comparative Assessment of Platinum Salts and Taxane Group Hypersensitivity Reactions, The Role of Skin Tests in Diagnosis?

Journal of Oncology Pharmacy Practice ◽

10.1177/10781552211050084 ◽

2021 ◽

pp. 107815522110500

Author(s):

Kadriye Terzioğlu ◽

Murat Ayhan

Keyword(s):

Skin Test ◽

Skin Tests ◽

Hypersensitivity Reactions ◽

Positive Skin ◽

Suspect Drug ◽

Platinum Salts ◽

Grade 3 ◽

Pain Symptoms ◽

Very High

Purpose We aimed to investigate the role of skin tests (ST) in the diagnosis of hypersensitivity reactions (HSRs) with platinum salts (PS) and taxane (TX) groups drugs and their reliability in patient management. Materials and Method Patients' data who developed immediate HSR with PS and TX were recorded and ST was performed. The gradual challenge was applied to all patients with ST negative and grade 1–2 with the suspect drug. Results In total, the data of 104 patients (74 with PS, 30 with TX) who developed HSR against PS and TX were shared. The gradual challenge was applied to 72 ST negative and grade 1–2 patients (46 PS group, 26 TX group). The gradual challenge was negative in 39 patients in the PS group and 23 patients in the Tx group. The negative predictive value (NPV) for PS was 83% and NPV for TX was 88%. We found significantly higher skin test positivity in patients with PS and TX and grade 3 HSR ( p = 0.007, p = 0.001). A significant correlation was found between skin test positivity and early onset of symptoms ( p = 0.001 for PS, p = 0.015 for TX). In terms of symptoms witnessed in HSR, we observed the itching, urticaria, hypotension, syncope, and abdominal pain symptoms significantly more in the group with a positive skin test ( p < 0.024, p < 0.001, p < 0.001, p < 0.002, and p < 0.025, respectively). Conclusions We found very high NPV values for PS and TX. We found that the gradual challenge applied to patients with negative skin tests is reliable if Grade 3 HSR is not observed and with this approach, unnecessary desensitization processes and/or drug alterations can be avoided.

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Assessment of immediate and non-immediate hypersensitivity contrast reactions by skin tests and provocation tests: A review

International Journal of Immunopathology and Pharmacology ◽

10.1177/20587384211015061 ◽

2021 ◽

Vol 35 ◽

pp. 205873842110150

Author(s):

Rakesh D Bansie ◽

A Faiz Karim ◽

Maurits S van Maaren ◽

Maud AW Hermans ◽

Paul LA van Daele ◽

...

Keyword(s):

Contrast Media ◽

Skin Test ◽

Positive Skin Test ◽

Skin Tests ◽

Hypersensitivity Reactions ◽

Immediate Hypersensitivity ◽

Positive Skin ◽

Provocation Tests ◽

Iodinated Contrast ◽

Negative Skin Test

Introduction: Allergic and nonallergic hypersensitivity reactions to iodinated contrast media (ICM) and gadolinium-based contrast media are classified as immediate or non-immediate hypersensitivity reactions (IHR and NIHR), respectively. Skin tests and provocation tests are recommended for the evaluation of hypersensitivity reactions to contrast agents; however provocations are not common in clinical practice. Methods: A MEDLINE search was conducted to investigate studies comprising both skin tests and provocation tests that evaluated hypersensitivity reactions to ICM. Results: Nineteen studies were identified that reported on skin tests, followed by provocations. In the case of IHR to ICM, 65/69 (94%) patients with a positive skin test for the culprit media tolerated a challenge with a skin-test-negative alternative ICM. In IHR to ICM with a negative skin test for the culprit media, provocations were positive in 3.2%–9.1% patients. In the case of a NIHR to ICM with a positive skin test, provocation with a skin-test-negative agent was tolerated in 75/105 (71%) of cases. In NIHR with a negative skin test for the culprit agent, re-exposure to the culprit or an alternative was positive in 0%–34.6% patients. Provocations with the same ICM in skin test positive patients with IHR or NIHR were positive for a majority of the patients, although such provocation tests were rarely performed. Data on hypersensitivity reactions, skin tests and provocations with gadolinium-based contrast media were limited; however, they exhibited a pattern similar to that observed in ICM. Conclusion: In both ICM and gadolinium-based contrast media, the risk of an immediate repeat reaction is low when skin tests are negative. In contrast, a provocation with a skin-test-positive contrast medium showed a high risk of an immediate repeat hypersensitivity reaction. Therefore, a thorough medical history is necessary, followed by skin tests. A provocation is recommended, for diagnostic work-up, when the diagnosis is uncertain.

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