Allergy evaluation of hypersensitivity to platinium salts and taxanes: a six-year experience.

Abstract Background Hypersensitivity reactions (HSRs) to platinum salts (PS) and taxanes (TX) are a challenge to cancer management. Allergy evaluation based on skin tests (ST) and graded challenges can provide a diagnosis of an allergy to a suspected drug and indicate possible treatment with alternative same-class drugs. Objective This study aimed to estimate the negative predictive value of ST in the diagnosis of HSRs to TX and PS. Methods This multicenter study prospectively enrolled patients with a suspected HSRs to PS and TX. ST were performed for chemotherapy, drugs of the same pharmacological class and other agents (latex or co-treatments). For patients with negative ST, a graded challenge was performed by the cancer teams trained in allergy management. Results A total of 119 consecutive patients were included during a six-year period. ST results were positive for 58% of the cohort: for TX in 7 patients and for PS in 62 patients. Other agents were responsible for 4.2% of cases. Skin cross-reactivity were 50% for TX and 30% for PS. A graded challenge was performed in 14 patients for TX and in 50 patients for PS. Negative predictive values (NPV) for ST were 100% for TX and 92% for PS, with NPVs for individuals PS of 100% for cisplatin, 89% for oxaliplatin and 87% for carboplatin. Conclusions ST to PS or TX offered a high NPV, making allergy evaluation a key element in the management of cancer patients. Graded challenges can be safely performed by oncology teams trained in anaphylaxis management.