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Evaluation and management of hypersensitivity reactions to chemotherapy agents
  1. Elizabeth Huiwen Tham1,2,
  2. Yew Kuang Cheng3,
  3. Miah Hiang Tay4,
  4. Ana Patricia Alcasabas1,2,
  5. Lynette Pei-Chi Shek1,2
  1. 1University Children's Medical Institute, National University Hospital, Singapore, Singapore
  2. 2Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  3. 3Department of Allergy, Arthritis & Rheumatism Clinic, Gleneagles Medical Centre, Singapore, Singapore
  4. 4Oncocare Clinic, Gleneagles Medical Centre, Singapore, Singapore
  1. Correspondence to Lynette Pei-Chi Shek, Division of Allergy & Immunology, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute (KTP-NUCMI), 1E Kent Ridge Road, NUHS Tower Block Level 12, Singapore 119228, Singapore; lynette_shek{at}nuhs.edu.sg

Abstract

Hypersensitivity reactions to chemotherapy drugs pose significant difficulties in management, especially when no suitable alternative is available or acceptable and delay in continuation of treatment may be life-threatening. Such reactions may be IgE- or non-IgE-mediated and have varied manifestations. Timely recognition and treatment of life-threatening hypersensitivity reactions are essential. Identification of patients at high risk of developing hypersensitivity reactions allows risk stratification to guide clinical decision-making. Skin testing for carboplatin hypersensitivity has good predictive value but is not yet established for oxaliplatin and taxane hypersensitivity. Rapid desensitisation may be considered if no suitable alternative drug is available. Available protocols have shown good safety and efficacy but must be performed in an appropriate setting with adequate monitoring. There are many avenues for research into the utility of skin testing for other chemotherapy agents as well as in vitro tests.

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