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Hypersensitivity to cisplatin on second rechallenge despite a successful first rechallenge

Department of Pharmacy, Westmead Hospital

Connie H. Katelaris

Department of Immunology, Westmead Hospital

Paul R. Harnett

Department of Medical Oncology, Westmead Hospital, Westmead, Australia

Objective. The need for vigilance in patients who exhibit cisplatin drug hypersensitivity, even after successful rechallenge is illustrated.

Clinical features. The patient was a 43-year-old woman presenting with relapsed ovarian cancer. On initial presentation 2 years earlier, she had developed a marked allergic reaction on her sixth cycle of cisplatin and cyclophosphamide chemotherapy. She was successfully rechallenged with cisplatin on re lapse, following pretreatment with antihistamines and corticosteroids. On the following cycle she redevel oped a major hypersensitivity reaction with tachycar dia, tachypnoea, hypotension, shakes, sweating and headache acutely into the cisplatin infusion, despite compliance with the previously effective premedica tion regimen.

Case progress and outcome. Adrenaline, hy drocortisone, and promethazine were administered intravenously and oxygen and salbutamol were in haled and the patient settled over 10 minutes. Regular oral promethazine therapy was maintained overnight. Further therapy with cisplatin was withheld and the patient went on to complete 4 cycles of single agent paclitaxel, which were well tolerated.

Conclusion. Patients exhibiting hypersensitivity reactions to platinum complexes that are successfully rechallenged following steroid and antihistamine pre- medication are still potentially at risk of systemic reactions. Vigilant patient care should be maintained on subsequent cycles and adrenaline, corticosteroids and antihistamines should be made available on stand-by.

Journal of Oncology Pharmacy Practice, Vol. 2, No. 2, 117-119 (1996)
DOI: 10.1177/107815529600200205


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