Byung-Keun Kim, MD
,
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
Min-Koo Kang, MD
,
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
Jiyoung Lee
,
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
Ju-Young Kim, MD
,
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
Woo-Jung Song, MD
,
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
Hye-Ryun Kang, MD, PhD
,
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
Heung Woo Park, MD, PhD
,
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
Sang-Heon Cho, MD, PhD
,
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
Kyung-up Min, MD, PhD
,
Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
Background: Hypersensitivity reaction to paclitaxel occurs frequently and sometime it can be life-threatening. However, a consensus for the management of the paclitaxel hypersensitivity reaction has not been reached.
Method: We analyzed database of individual case safety reports of Seoul National University Hospital from 2010 to 2014. Its severity was classified using Common Terminology Criteria for Adverse Events version 4.3.
Result: There were 189 cases of paclitaxel hypersensitivity reaction. Frequent underlying diseases were ovarian cancer (35.0%) in women and lung cancer (54.3%) in men. Most frequent type of hypersensitivity reactions were cutaneous symptoms (77.1%). Hypersensitivity reaction occurred during and after infusion in 72.8% and 19.1%, respectively. Grade 2 reactions were most common (64%) and severe reactions of grade 3 and 4 reactions account for 9%. According to of chemotherapy cycles, 79.9% of hypersensitivity reaction occurred within the 3rd cycle and hypersensitivity reaction over grade 3 were not found in cases developed after the 5th cycle. Among 159 cases which continued next cycles of paclitaxel chemotherapy, 13.1% of grade 1-2 reaction and 14.3% of grade 3-4 reactions were continued paclitaxel chemotherapy with additional dose of premedication while 22.1% of grade 1-2 reaction and 57.1% of grade 3-4 reaction were treated with modified infusion protocol including desensitization.
Conclusion: Most of paclitaxel hypersensitivity reaction appears early after starting infusion but 19.1% occurred after completion of paclitaxel infusion. High-grade hypersensitivity reaction to paclitaxel accounts for 9% and most of them needed protocol modification or additional premedication.
