Retrospective study of immediate hypersensitivity (IHS) reactions
to platinum salts in the University Hospital of Nancy
T. ADAM1,2, A-C. BURSZTEJN1, C.
MOUTON-FAIVRE1
1 Dermatology and Allergology Department, University
Hospital of Nancy, Vandoeuvre les Nancy, France;
2Pediatric Allergy Department, Children’s Hospital,
University Hospital of Nancy, Vandoeuvre les Nancy, France;
Dear Editor,
Fifty-eight patients (10 male; 48 female) were referred to the
University Hospital of Nancy for an IHS (Immediate Hypersensitivity) to
platinum salts after having experienced a reaction corresponding to
Ring&Messmer’s classification (e.g. generalised erythema for grade I or
cardiovascular collapse for grade III). All patients were examined
between February 2015 and August 2021. Skin prick tests (SPT) for all
three platinum salts were performed: oxaliplatin and cisplatin (0.1;
1mg/mL), and carboplatin (1,10mg/mL). If SPT remained
negative, intradermal tests (IDR) were performed at concentrations
from 0.01 to 1mg/ml for oxaliplatin and cisplatin
and 0.1 to 10 mg/mL for carboplatin.
Thirty-one of the 58 patients who had presented a grade I (25) or II (6)
reaction (according to Ring&Messmer’s classification) and had negative
tests to platinum salts were able to continue their chemotherapy with an
extended perfusion period. Among the 27 remaining patients who had
presented a grade II or III reaction (generalized erythema, hypotension,
tachycardia, vomiting) within the first ten minutes of the perfusion, we
recorded a positive SPT for 13 (10 carboplatin, 1 cisplatin and 2
oxaliplatin), and only a positive IDR for the 14 others (8 carboplatin
and 6 cisplatin). In most cases (17/27) only erythema and not urticaria
was observed. Assay of tryptase was never performed. Desensitization
protocol was offered to 12 patients who had positive skin tests because
the culprit platinum salt was considered as essential by the
oncologists. Desensitization was successful for 9 patients using a
12-step protocol. Two failed due to urticaria at steps 8 and 12 and one
due to lipothymia with erythema of the neckline and abdominal pain at
step 11. An alternative platinum salt or a different chemotherapy was
chosen for the other 15 patients with positive skin tests.
Conclusion:
Skin tests are effective in the assessment of IHS to platinum salts and
highlight a strong correlation with the reaction’s
severity2,3,4. Beside it is essential to test platinum
salts at pure concentration as our experience showed us that 3 patients
only had positive IDR at 10mg/mL for carboplatin and 1mg/mL for
cisplatin. These results demonstrate that negative skin tests enable the
reintroduction of the culprit platinum salt by extending the perfusion
period. In the case of positivity of SPT or IDR (probably IgE-dependant
mechanism), desensitization can be performed in step 12 or 16, depending
on the severity of the reaction5.
We have no conflict of interest to declare.
In line with the French Government policy, the local Ethic board
approvment is not needed in monocentric retrospective studies.
Patients were writtenly informed that their health data could be used
for scientific studies purposes unless otherwise written request (as
specified in the French Public Health Code law number 78-17
6th January 1978 and UE settlement 2016/769 on the
protection of personal data.
Bibliography :
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2008;122(3):574‑80.
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5. Brault F, Waton J, Poreaux C, Schmutz J-L, Barbaud A.
Hypersensibilité aux sels de platine et aux taxanes : intérêt des tests
cutanés et des inductions de tolérance. Ann Dermatol Vénéréologie. 2017
Nov 1;144(11):685–95.
Corresponding author :
Tania ADAM
CHRU Nancy
Rue du Morvan
54500 Vandoeuvre-Lès-Nancy
France
t.adam@chru-nancy.fr