Objective: Patients receiving repeated chemotherapy cycles may develop hypersensitivity reactions due to sensitization. Rapid drug desensitization protocols allow safe reintroduction of the culprit chemotherapeutics. This study aimed to evaluate the clinical characteristics of patients who underwent rapid drug desensitization in our clinic and to analyze the features and predictors of breakthrough reactions.
Materials and Methods: After ethics committee approval, patients who underwent rapid drug desensitization with chemotherapeutic agents between 2019 and 2024 were retrospectively reviewed. Demographic data, initial hypersensitivity reaction profiles, skin test results, and breakthrough reactions were analyzed.
Results: 29 patients, including 26 females and 3 males with a mean age of 53.1 ± 10.8 years, were included. Rapid drug desensitization was performed with platinum agents in 18 patients and with taxanes in 11 patients. The platinum group was older than the taxane group, with mean ages of 56.5 ± 10.3 and 47.5 ± 9.6 years, respectively (p = 0.028). Initial hypersensitivity reactions were type I (immediate) hypersensitivity reactions in 14, cytokine release reaction in 1, and mixed-type in 3 platinum cases, and type I (immediate) hypersensitivity reactions in 8, cytokine release reaction in 1, and mixed-type in 2 taxane cases. Platinum-related reactions occurred at the 6th cycle after 30 minutes, versus the 1st cycle at 5 minutes for taxanes (p < 0.05). Skin tests were positive in 11 platinum patients and 1 taxane patient (p = 0.027). Breakthrough reactions were more frequent in patients with positive skin tests (p = 0.024) and in those with urogenital malignancies (p = 0.024). Of the 104 desensitization procedures, all but one were successfully completed.
Conclusion: Rapid drug desensitization is a safe and effective approach for managing chemotherapy-induced hypersensitivity reactions. Taxane-related reactions occur earlier, and positive skin tests or urogenital malignancy may predict breakthrough reactions.