As the use of chemotherapeutic agents increased rapidly in recent years, more patients are under the potential risk of chemotherapy related adverse reactions. Multiple regular exposures to the same drug by chemotherapy protocol may increase the risk of sensitization to a chemotherapeutic agent, which can result in hypersensitivity reactions. Once severe hypersensitivity reactions occur, causative drugs should be avoided. However, a substitute with equal efficacy is not always available. When there is no effective alternative, desensitization is a safe tool for maintenance of chemotherapeutic agents causing hypersensitivity reaction. In this review, we introduce the latest knowledge about desensitization protocol for chemotherapeutic agents which are frequently used recently.
Antineoplastic Agents ; Desensitization, Immunologic ; Drug Hypersensitivity ; Drug Therapy* ; Humans ; Hypersensitivity*

Humans ; Hypersensitivity ; drug therapy ; Probiotics ; therapeutic use

The diagnosis of anaphylaxis is often based on reported symptoms which may not be accurate and lead to major psychosocial and financial impacts. We describe two adult patients who were diagnosed as having recurrent anaphylaxis witnessed by multiple physicians based on recurrent laryngeal symptoms. The claimed cause was foods in one and drugs in the other. We questioned the diagnosis because of absent documentation of objective findings to support anaphylaxis, and the symptoms occurred during skin testing though the test sites were not reactive. Our initial skin testing with placebos reproduced the symptoms without objective findings. Subsequent skin tests with the suspected allergens were negative yet reproduced the symptoms without objective findings. Disclosing the test results markedly displeased one patient but reassured the other who subsequently tolerated the suspected allergen. In conclusion, these 2 patients' symptoms and evaluation were not supportive of their initial diagnosis of recurrent anaphylaxis. The compatible diagnosis was Munchausen stridor which requires psychiatric evaluation and behavior modification, but often rejected by patients.
Adult ; Allergens ; Anaphylaxis* ; Behavior Therapy ; Diagnosis ; Drug Hypersensitivity ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Placebos ; Respiratory Sounds ; Skin Tests ; Vocal Cord Dysfunction

Drug-induced anaphylaxis is a big pitfall in patients receiving antineoplastic chemotherapy. We report a case of lung cancer patient who experienced two near-fatal anaphylactic reactions that resulted from paclitaxel and multivitamin, seperately. Recurrent severe reactions to different agents led to further investigation to which material the patient was hypersensitive. The skin prick test revealed sensitization to cremophor, which is a commonly used emulsifying agent. This case emphasizes the importance of correctly identifying the culprit drug of anaphylaxis to avoid potentially fatal reaction.
Anaphylaxis* ; Drug Therapy ; Humans ; Hypersensitivity ; Lung Neoplasms ; Paclitaxel ; Skin

Drug desensitization is procedure by which patients can be tolerized to medications that have previously induced hypersensitivity reactions. Initially used in treating hypersensitivity reactions to antibiotics, desensitization is now frequently used in the setting of allergy to chemotherapy drugs and biologics, thus widening the clinical applicability of this procedure which has been proven to be quite safe and effective in improving clinical outcomes, mainly by allowing patients to remain on preferred first-line therapy. This paper reviews the history, application, and safety studies of drug desensitization for chemotherapy and biologics.
Anaphylaxis ; Anti-Bacterial Agents ; Biological Products ; Drug Therapy ; Humans ; Hypersensitivity

Oxaliplatin is a third-generation platinum compound that is used as a single agent and in combination with fluorouracil (5-FU) to treat colorectal and gastric carcinoma. The patients treated with oxaliplatin may develop hypersensitivity and idiosyncratic reactions, although these complications are known to be rare. We report here on two patients who suffered with metastatic colorectal cancer and who underwent palliative combination chemotherapy with oxaliplatin; they then developed hypersensitivity reactions to oxaliplatin. The first case had an anaphylatic reaction immediately after the beginning of the 7(th) to 8(th) cycle infusion of oxaliplatin. The second case developed repeated febrile episodes from the 4th to 8th cycles of oxaliplatin infusion. With the increasing use of oxaliplatin in clinical practice, we are now encountering an increasing incidence of suspected hypersensitivity reactions. Physicians should keep their eyes wide open and carefully observe for the clinical manifestations of these hypersensitivity reactions.
Colorectal Neoplasms ; Drug Therapy ; Drug Therapy, Combination ; Fluorouracil ; Humans ; Hypersensitivity* ; Incidence ; Platinum

OBJECTIVE: To report on the incidence of nab-paclitaxel hypersensitivity reactions (HSRs) in patients with prior taxane HSR. METHODS: From 2005 to 2015, all patients who received nab-paclitaxel for a gynecologic malignancy were identified. Chart abstraction included pathology, prior therapy, indication for nab-paclitaxel, dosing, response, toxicities including any HSR, and reason for discontinuation of nab-paclitaxel therapy. RESULTS: We identified 37 patients with gynecologic malignancies with a history of paclitaxel HSR who received nab-paclitaxel. Six patients (16.2%) had a prior HSR to both paclitaxel and docetaxel while the other 31 patients had not received docetaxel. No patients experienced a HSR to nab-paclitaxel. Median number of cycles of nab-paclitaxel was 6 (range 2–20). Twelve patients received weekly dosing at 60 to 100 mg/m². The remainder of patients received 135 mg/m² (n=13), 175 mg/m² (n=9), or 225 mg/m² (n=3). Thirty four patients (91.9%) received nab-paclitaxel in combination with carboplatin (n=28, 75.7%), IP cisplatin (n=1, 2.7%), carboplatin and bevacizumab (n=3, 8.1%), or carboplatin and gemcitabine (n=2, 5.4%). Reasons for discontinuing nab-paclitaxel included completion of adjuvant therapy (n=16), progressive disease (n=18), toxicity (n=1), and death (n=1). There were no grade 4 complications identified during nab-paclitaxel administration. Grade 3 complications included: neutropenia (n=9), thrombocytopenia (n=4), anemia (n=1), and neurotoxicity (n=1). CONCLUSION: Nab-paclitaxel is well-tolerated with no HSRs observed in this series of patients with prior taxane HSR. Given the important role of taxane therapy in nearly all gynecologic malignancies, administration of nab-paclitaxel should be considered prior to abandoning taxane therapy.
Albumin-Bound Paclitaxel ; Anemia ; Bevacizumab ; Carboplatin ; Cisplatin ; Drug Hypersensitivity ; Drug Therapy ; Humans ; Hypersensitivity* ; Incidence ; Neutropenia ; Paclitaxel ; Pathology ; Thrombocytopenia

Itraconazole, new triazole agent with a broader antifungal spectrum than fluconazole, has been prescribed widely in the treatment and prophylaxis for fungal infection. Itaconazole has been reported to have gastrointestinal disturbance (4%) and headache (1%) as its most common side-effects. However, allergic reactions caused by this drug are rare. A 53-year-old woman with myelodysplastic syndrome received prophylactic antibiotic therapy including itraconazole solution before chemotherapy. She complained of hive on the face with angioedema at 6 hours after taking them. The symptoms were more aggravated on the next day and reversed by stopping itraconazole solution and injection of antihistamine and steroids. Skin prick tests with itraconazole solution, itraconazole tablet, and ketoconazole showed all the negative responses. The oral challenge test with itraconazole solution was performed and resulted in urticaria and angioedema 6 hours later. Next, the oral challenge test with intraconazole tablet was performed and showed negative response. The patient was finally diagnosed as adverse reaction by additives contained intraconazole solution. We report, a case of delayed onset urticaria and angioedema caused by components of itraconazole solution.
Angioedema* ; Drug Therapy ; Female ; Fluconazole ; Headache ; Humans ; Hypersensitivity ; Hypersensitivity, Delayed ; Itraconazole* ; Ketoconazole ; Middle Aged ; Myelodysplastic Syndromes ; Skin ; Steroids ; Urticaria*

Stevens-Johnson syndrome (SJS), also known as the multifactorial erythematous drug eruption, is a class of adverse reactions of the skin and mucous membranes primarily caused by drug allergy often involving the oral cavity, eyes, and external genital mucosa, generally accompanied by fever, and can be life-threatening in severe cases. In February 2022, the Department of Stomatology, the First Affiliated Hospital of Zhengzhou University admitted a patient with huge inflammatory hyperplasia of bilateral lingual margins secondary to SJS. Upon admission, no other obvious symptoms were observed except for tongue hyperplasia. The patient suffered from a severe adverse drug reaction caused by acetaminophen 2 months ago and was complicated by liver dysfunction and pulmonary infection. After 1 month of treatment and rehabilitation, he developed a secondary tongue mass and was subsequently admitted to Dept. of Oral and Maxillofacial Surgery Ward 2, the First Affiliated Hospital of Zhengzhou University. After completing the examination, the tongue mass was surgically removed. After a follow-up of 11 months, the patient's condition was satisfactory and no temporary discomfort was observed. The case of tongue mass secondary to SJS is extremely rare. If a stomatologist encounters a similar case, we should carefully inquire about the drug allergy history and recent medication history, and be alert to whether or not they had adverse drug reactions recently.
Male ; Humans ; Stevens-Johnson Syndrome/drug therapy* ; Hyperplasia/pathology* ; Skin ; Drug Hypersensitivity/pathology* ; Tongue

Up to 5% of young children suffer from food allergy. Children with food allergy may present with a variety of symptoms that parents have attributed to constituents of the diet. The diagnosis and management of adverse food reactions is a challenge for physicians. Diagnostic approaches are composed of a detailed history, in vitro tests and in vivo tests. Improved diagnostic methods include more precise in vitro and in vivo tests for immunoglobulin E-mediated food allergies, in vitro assays for predicting development of oral tolerance, and novel non-invasive tests for cell-mediated food allergies such as patch testing, cytokine assays, and detection of eosinophil activation markers. The conventional diet therapy, pharmacotherapy and new immunomodulatory approaches to food allergy are also discussed. Rapidly evolving findings might provide hope for a cure of food allergy in the near future.
Child ; Diagnosis* ; Diet ; Diet Therapy ; Drug Therapy ; Eosinophils ; Food Hypersensitivity* ; Hope ; Humans ; Immunoglobulins ; Parents ; Patch Tests