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05. Miscellaneous
686 Non-immediate hypersensitivity reactions in patients with gynecologic and breast neoplasms and management with desensitization
  1. Teodorikez Wilfox Jimenez-Rodriguez1,2,
  2. Inmaculada Lozano Cubo3,
  3. María Niveiro De Jaime4,
  4. Laura Álvarez Nuñez5,
  5. Ana Yuste Izquierdo3,
  6. Francisco Javier Fernández Sánchez1,2,6,
  7. Rosa Ana Montoyo Antón7,8,
  8. Montserrat García Araque8,
  9. Elena Peña Zurdo8,
  10. Daniel Parra Trujillo3,
  11. Guillermo Forner Cuenca3,
  12. María José Roman-Sánchez9,
  13. Manuela Sala Ferichola9,
  14. Josefa Marcos Sanmartin9 and
  15. Amparo Burgos San José5
  1. 1Allergy Section, Dr. Balmis General University Hospital; Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
  2. 2ARADyAL Spanish Network (RD16/0006). Instituto de Salud Carlos III (ISCIII). Fundación Española para la Ciencia y la Tecnología (FECyT), Madrid, Spain
  3. 3Oncology Department, Dr. Balmis General University Hospital; Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
  4. 4Pathology Service, Dr. Balmis General University Hospital; Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
  5. 5Pharmacy Department, Dr. Balmis General University Hospital; Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
  6. 6Department of Clinical Medicine, Miguel Hernández University, ISABIAL, Alicante, Spain
  7. 7Oncology Day Hospital Nursing Service, Dr. Balmis General University Hospital; Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
  8. 8Oncology Clinical Trials Unit, Dr. Balmis General University Hospital; Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
  9. 9Gynecology and obstetrics Department, Dr. Balmis General University Hospital; Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain

Abstract

Introduction/Background Chemotherapy-induced reactions are mainly immediate hypersensitivity reactions (IHSR), however, non-immediate hypersensitivity reactions (NIHSR) have been described. NIHSRs usually reappear after each re-exposure, but sometimes can lead to the development of IHSRs, which is known as the ‘converter phenotype’. IHSRs can be of different phenotypes: type I (IgE or non-IgE mediated), cytokine release reactions (CRR), mixed (Mx) or indeterminate (Id).

NIHSRs are characterized by the onset of symptoms at least 6 hours after drug exposure and are thought to be mediated by T cells.

Methodology Between January 2018 and June 2023, 18 patients diagnosed with gynecological and breast neoplasms were evaluated because of NIHSR. One patient with ovarian (OC) and 5 with breast cancer (BC) presented NIHSRs; in addition 6 OC, 2 endometrial (EC) and 4 BC with converter phenotype were identified. All patients were sent for evaluation to the Allergy Section of the Dr. Balmis General University Hospital, Alicante-Spain. Patients‘ symptoms, skin biopsies, skin tests, biomarkers, and results of 83 DDs were retrospectively analyzed.

Results Paclitaxel was the culprit drug in all patients with NIHSRs. Most patients had maculopapular exanthema (MPE) (83%), flushing/warm (83%) and pruritus (50%). On the other hand, the converter phenotype was triggered by paclitaxel in 6 patients, carboplatin in 3, and docetaxel in 3. Clinically, NIHSRs manifested as MPE (58%), flushing/warm (25%) and pain (25%), among others. After switching to an IHSR, patients developed reactions of phenotype 1 (8%), CRR (58%), Mx (17%) and Id (17%).

83 DDs were performed, and 13 (16%) breakthrough reactions were observed: 4 IHSRs and 9 NIHSRs.

Conclusion DD protocols represent a safe and useful procedure not only for IHSR but also for NIHSR. Reintroduction of the culprit drug through DD may prevent the development of severe NIHSR, as well as prevent progression to IHSR after delayed reactions.

Disclosures None of the authors have a conflict of interest related to this presentation.

https://doi.org/10.1136/ijgc-2024-ESGO.518

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