Phenotypic Expression of Hypersensitivity Drug Reactions in Outpatient Infusion Centers, 1 Year Experience

Drug hypersensitivity reactions (HSRs) in outpatient infusion center have been underreported and no standard management avenue is established. The frequency of acute HSRs in general population is approximately 1%, but in inpatient and infusion center settings the frequency of HSRs is increased up to 25%. The aim of this study was to describe HSR phenotypes and management in three outpatient infusion clinics. A retrospective review was performed of patient reactions that included iron products, monoclonal antibodies, and chemotherapeutic agents at three Dana-Farber Satellite Clinics (DFSC) from March 2016-April 2017. The classification of the clinical symptoms was divided in to three phenotypes: Type I (IgE medicated, involving mast cells), Cytokine-Release Reaction (CRR), Mixed reactions (clinical symptoms including Type 1 an CRR); as well as, grade of reaction, and outcomes was collected. 6495 infusions were administrated at these outpatient centers and 82 HSRs were documented; Iron products represented 47% of reactions, taxanes 13%, and platins 8.5%. The phenotype of the reactions varied from Mixed 51%, Type I 25%, and CRR 18%. The degree of severity varied between drugs, most reactions were grade II (60%) associated to iron products and grade III (12%) were associated with chemotherapeutics and monoclonal antibodies. No epinephrine was administrated for any reaction. The use of Epinephrine should be promoted for patients presenting a grade III reactions. Standardized management, early recognition, and phenotype classification protocols that support the providers in managing these reactions in the outpatient setting to improve outcomes.