Unsuccessful Desensitization to Paclitaxel in a Patient With High Basophil Sensitivit

摘要

Immediate hypersensitivity reactions (HSRs) occur during the administration of taxanes in 10%-30% of patients and are severe in up to 10% [1]. Desensitization has proven to be safe and successful in most cases of HSR, enabling patients to be retreated with taxanes [2]. However, even during desensitization, HSRs can occur in 15% of treated patients regardless of the severity of the initial reaction or skin test results. Reactions during desensitization are severe in 13%, regardless of the initial reaction. Since measurement of specific IgE to taxanes is not commercially available [3], the basophil activation test (BAT) could prove useful for detecting IgEmediated reactions. The BAT result was already shown to be a relevant biomarker of the outcome of rapid desensitization in allergy to platinum compounds [4]. Data on diagnostic testing for taxane allergy are scarce and often limited to case reports [1,3,5]. To the best of our knowledge, the utility of BAT in taxane allergy has not been fully evaluated. In food and insect venom, the allergic sensitivity of basophils can predict the severity and threshold of allergic reactions to allergens [6], although such experiences in drug allergies are limited [4,7]. We report a case of a highly positive BAT result to paclitaxel in a patient with severe HSR at very low concentrations of paclitaxel during initial treatment and an attempt at desensitization.