Experience with Desensitizations to Taxanes in an Allergy Department in Madrid (Spain)

Rationale: Desensitization to taxanes allows to continue standard front-line treatments in patients with infusional reactions.

Methods: A descriptive-retrospective analysis was performed. Clinical records of patients with desensitizations to taxanes, from January 2008-July 2015, were reviewed.

Results: Thirty-two patients (21 paclitaxel; 11 docetaxel) with immediate reactions (IR) (15% mild, 42% moderate and 43% severe) and one with a mild delayed reaction, were selected. Mean age 53.2±12.2, 91% female. Symptoms were: 75% cutaneous, 70% respiratory, 49% abdominal, 39% cardiovascular, 36% back pain and 21% neurological. Intradermal tests (IDT) were positive in 2 patients with IR to docetaxel.

They completed 137 desensitization cycles. All patients started with a standard 12-step protocol, initially adapted in most of them (91%) according to the severity of the initial reaction. Modifications included: pretreatment (81%: 85% received AAS-montelukast and 15% montelukast), increased final flow (74%) and additional steps (9%).

There were 12 IR in 137 cycles (8.7%) in 10 patients. The reactions were less severe (75% mild, 25% moderate) than their original reaction. Seven of them required new cycles. The protocol was modified in 5 without new reactions (pretreatment before certain steps 75%, additional step 50% and increase the length of a step 25%). One of the 2 patients without a new modification developed a reaction.

There was one patient who withdrew the treatment.

Conclusions: A initial adaptation of the desensitization protocol according the severity of reactions may increase its tolerance.

Most of the patients tolerated increased flow rates at the last steps, narrowing the procedure.