Experience With Desensitizations To Taxanes In An Allergy Department In Madrid (Spain)

RationaleDesensitization to taxanes allows to continue standard front-line treatments in patients with infusional reactions.MethodsA descriptive-retrospective analysis was performed. Clinical records of patients with desensitizations to taxanes, from January 2008-July 2015, were reviewed.ResultsThirty-two patients (21 paclitaxel; 11 docetaxel) with immediate reactions (IR) (15% mild, 42% moderate and 43% severe) and one with a mild delayed reaction, were selected. Mean age 53.2±12.2, 91% female. Symptoms were: 75% cutaneous, 70% respiratory, 49% abdominal, 39% cardiovascular, 36% back pain and 21% neurological. Intradermal tests (IDT) were positive in 2 patients with IR to docetaxel.They completed 137 desensitization cycles. All patients started with a standard 12-step protocol, initially adapted in most of them (91%) according to the severity of the initial reaction. Modifications included: pretreatment (81%: 85% received AAS-montelukast and 15% montelukast), increased final flow (74%) and additional steps (9%).There were 12 IR in 137 cycles (8.7%) in 10 patients. The reactions were less severe (75% mild, 25% moderate) than their original reaction. Seven of them required new cycles. The protocol was modified in 5 without new reactions (pretreatment before certain steps 75%, additional step 50% and increase the length of a step 25%). One of the 2 patients without a new modification developed a reaction.There was one patient who withdrew the treatment.ConclusionsA initial adaptation of the desensitization protocol according the severity of reactions may increase its tolerance.Most of the patients tolerated increased flow rates at the last steps, narrowing the procedure. RationaleDesensitization to taxanes allows to continue standard front-line treatments in patients with infusional reactions. Desensitization to taxanes allows to continue standard front-line treatments in patients with infusional reactions. MethodsA descriptive-retrospective analysis was performed. Clinical records of patients with desensitizations to taxanes, from January 2008-July 2015, were reviewed. A descriptive-retrospective analysis was performed. Clinical records of patients with desensitizations to taxanes, from January 2008-July 2015, were reviewed. ResultsThirty-two patients (21 paclitaxel; 11 docetaxel) with immediate reactions (IR) (15% mild, 42% moderate and 43% severe) and one with a mild delayed reaction, were selected. Mean age 53.2±12.2, 91% female. Symptoms were: 75% cutaneous, 70% respiratory, 49% abdominal, 39% cardiovascular, 36% back pain and 21% neurological. Intradermal tests (IDT) were positive in 2 patients with IR to docetaxel.They completed 137 desensitization cycles. All patients started with a standard 12-step protocol, initially adapted in most of them (91%) according to the severity of the initial reaction. Modifications included: pretreatment (81%: 85% received AAS-montelukast and 15% montelukast), increased final flow (74%) and additional steps (9%).There were 12 IR in 137 cycles (8.7%) in 10 patients. The reactions were less severe (75% mild, 25% moderate) than their original reaction. Seven of them required new cycles. The protocol was modified in 5 without new reactions (pretreatment before certain steps 75%, additional step 50% and increase the length of a step 25%). One of the 2 patients without a new modification developed a reaction.There was one patient who withdrew the treatment. Thirty-two patients (21 paclitaxel; 11 docetaxel) with immediate reactions (IR) (15% mild, 42% moderate and 43% severe) and one with a mild delayed reaction, were selected. Mean age 53.2±12.2, 91% female. Symptoms were: 75% cutaneous, 70% respiratory, 49% abdominal, 39% cardiovascular, 36% back pain and 21% neurological. Intradermal tests (IDT) were positive in 2 patients with IR to docetaxel. They completed 137 desensitization cycles. All patients started with a standard 12-step protocol, initially adapted in most of them (91%) according to the severity of the initial reaction. Modifications included: pretreatment (81%: 85% received AAS-montelukast and 15% montelukast), increased final flow (74%) and additional steps (9%). There were 12 IR in 137 cycles (8.7%) in 10 patients. The reactions were less severe (75% mild, 25% moderate) than their original reaction. Seven of them required new cycles. The protocol was modified in 5 without new reactions (pretreatment before certain steps 75%, additional step 50% and increase the length of a step 25%). One of the 2 patients without a new modification developed a reaction. There was one patient who withdrew the treatment. ConclusionsA initial adaptation of the desensitization protocol according the severity of reactions may increase its tolerance.Most of the patients tolerated increased flow rates at the last steps, narrowing the procedure. A initial adaptation of the desensitization protocol according the severity of reactions may increase its tolerance.