Paclitaxel
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Immediate hypersensitivity reactions: case report A 50-year-old woman developed immediate hypersensitivity reactions (HSRs) during treatment with paclitaxel for HER2-positiveand oestrogen receptor positive breast cancer. The woman had been receiving adjuvant chemotherapy with paclitaxel infusion weekly [dose and exact route and not stated] along with trastuzumab and pertuzumab following premedication. However, within 5 minutes after initiation of the second paclitaxel infusion, she developed grade 4 HSRs manifested as dyspnoea, abdominal cramps, generalised erythema, tachycardia, low oxygen saturation and hypotension. Paclitaxel was stopped, and the woman was treated with clemastine, methylprednisolone, sodium chloride [saline] and oxygen. The woman was restarted on paclitaxel 1h after receiving premedication with dexamethasone and clemastine. After receiving 15mL of infusion, she developed grade 1 HSRs with abdominal cramps, increased heart rate and dyspnoea with oxygen saturation 95%. The paclitaxel infusion was stopped again, and she was treated with clemastine and methylprednisolone. Her intradermal test was positive with paclitaxel at 0.01 mg/mL while prick test was negative. A basophil activation test (BAT) was performed. After paclitaxel stimulation at various concentrations ranged 0.005–50 µg/mL, her CD63+ basophil percentage was increased as: 2, 67, 62, 69 and 80. The BAT was found to be highly positive even at low concentrations. The BAT was negative in healthy controls and non-allergic controls after allergen-exposure. Thereafter, she received premedication with ranitidine, montelukast, methylprednisolone and clemastine. A 12-step desensitisation protocol with paclitaxel was then started. At the cumulative paclitaxel dose of 0.022mg, she developed pruritus and generalised erythema. She received treatment with clemastine and epinephrine [adrenaline], and the desensitisation was discontinued. The following day, she was started on 16-step protocol, but developed generalised urticaria at 0.010mg paclitaxel. Her desensitization was stopped again, and she was treated with clemastine and epinephrine. After 30 min, the desensitisation was restarted, but she again developed generalised urticaria at a cumulative paclitaxel dose of 0.023mg. Therefore, the paclitaxel was discontinued. Kopac P, et al. Unsuccessful Desensitization to Paclitaxel in a Patient with High Basophil Sensitivity. Journal of Investigational Allergology and Clinical Immunology 31: No. 803498621 3, 2021. Available from: URL: http://doi.org/10.18176/jiaci.0590
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Reactions 29 Aug 2020 No. 1819
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