Original Article
Low Cross-Reactivity Between Cisplatin and Other Platinum Salts

https://doi.org/10.1016/j.jaip.2019.01.057Get rights and content

Background

Hypersensitivity reactions to platinum salts (PS) (cisplatin [CI], carboplatin [CA], and oxaliplatin [OX]) can be severe and their incidence is increasing due to their widespread use in cancer treatment.

Objective

To determine the rate of cross-reactivity between PS and whether CI can be administered without prior allergy testing in patients with a history of CA or OX hypersensitivity.

Methods

From September 2002 to April 2016, patients with suspected immediate PS hypersensitivity were tested and cross-reactivity between the 3 PS was evaluated. We then studied patients who were given CI without desensitization after immediate hypersensitivity to other PS.

Results

A total of 155 patients were included. Skin tests were positive in 97 patients (OX: 51, CA: 43, and CI: 3). Cross-reactivity to CA in OX-allergic patients was 45% (23 of 51) (95% confidence interval [CI]: 36% to 66%) and cross-reactivity to OX in CA-allergic patients was 37% (16 of 43) (95% CI: 23% to 53%). In contrast, cross-reactivity to CI was 0% (0 of 51) (95% CI: 0% to 7%) in OX-allergic patients and 7% (3 of 43) (95% CI: 2% to 17%) in CA-allergic patients. All these 3 patients had previously been exposed to CI in previous courses of chemotherapy. CI was initiated in 24 patients with proven hypersensitivity to CA or OX and had no hypersensitivity reactions.

Conclusion

Initiating CI in patients with proven immediate hypersensitivity to CA or OX appeared to be safe in our study.

Section snippets

Methods

We conducted a retrospective, descriptive, single-center study from September 2002 to April 2016 at the Dermatology Department of Dijon University Hospital, France. Patients coming for a dermato-allergology consultation for immediate hypersensitivity reactions to PS were included. An immediate reaction to PS was defined as a reaction that occurs during the infusion or within 1 hour after the infusion of one of the 3 PS (CA, OX, or CI). Skin tests were performed after a minimum of 4 to 6 weeks

Patients

During the 14-year study period, 184 patients had investigations for hypersensitivity reactions to PS. Among these patients, 29 were not analyzed because they had a delayed rather than immediate reaction. Finally, 155 remaining patients with immediate hypersensitivity were included (see Figure 1). Patients' clinical data are summarized in Table I.

Treatments and hypersensitivity reactions

The suspected PS was CA in 64 cases, OX in 87 cases, and CI in 4 cases. The median number of courses administered until the reaction occurred was 9

Discussion

Hypersensitivity to PS was first described by Hunter et al32 in 1945 among employees working in a refinery. Since then, the incidence of hypersensitivity has risen because of the widespread use of PS in many cancers treatments. Skin testing has proven to be helpful in the diagnosis of IgE-mediated hypersensitivity to a PS.22, 25, 29

We present here a study with a large number of patients tested after immediate hypersensitivity to PS. Our study included 155 patients with the same baseline

Acknowledgment

We thank the nurses for consultations and the secretaries of the Dermatology Department, Dijon University Hospital, Dijon, France, the staff of the archives of Centre Georges-François Leclerc, Dijon, France, and Mr. Philip Bastable, Research Unit at Dijon University Hospital.

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    No funding was received for this work.

    Conflicts of interest: The authors declare that they have no relevant conflicts of interest.

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