Hypersensitivity reactions to platinums: Systematic review of efficacy and safety of desensitization.

Abstract

e23326 Background: Platinum compounds carry a significant risk of hypersensitivity reactions (HSR), and repeated exposures can lead to IgE-mediated sensitization, culminating in allergic symptoms and anaphylaxis. Drug desensitization offers a temporary immunological tolerance, allowing for the safe reintroduction of platinum-based therapies in allergic individuals. Methods: To evaluate the safety and effectiveness of rapid drug desensitization (RDD) for platinum-related hypersensitivity reactions, we conducted a systematic review. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered our study in PROSPERO (CRD42023473211). A thorough literature search was performed across the Medline, Embase, Web of Science, and Scopus databases. Results: A total of 53 studies were included (n = 2853) from 11 countries between 1998 and 2024, patients with initial HSR to platinums, carboplatin (n = 44), oxaliplatin (n = 30) and cisplatin (n = 23) that underwent a desensitization. The symptoms of HSR to platinum were skin and respiratory. There was variability in the type of desensitization protocols used, the most frequent being 4 bags-4 steps and 3-4 bags and 12-16 steps, with an average duration of 5.7 2.5 hours. Premedication was reported in most cases (n = 49), consisting mainly of antihistamines, corticosteroids and leukotriene antagonists. Patients tolerated the desensitization protocol; the success rate at desensitization with carboplatin and oxaliplatin varied between 67-100%, while it was 100% in all cases of desensitization for cisplatin. An incidence of HSR during desensitization was reported, ranging from 4.4% to 96.7% (median of 24%), and no associated deaths. Conclusions: Rapid drug desensitization (RDD) is an effective procedure for patients with platinum-induced hypersensitivity reactions, enabling safe re-exposure to carboplatin, cisplatin, and oxaliplatin, thereby improving quality of life and ensuring the continuation of first-line therapy.