Exploration of hypersensitivity to injectable chemotherapies: a 14-year retrospective monocentric study of the impact of this activity in our Centralized Cytotoxic Preparation Unit

Objective
Hypersensitivity reactions (HSR) are potentially life-threatening adverse effects of cytotoxic drugs, which may require discontinuation (1). The imputability of a drug for causing HSR is assessed during an allergological workup, which includes skin tests (ST) (2).
All types of cancer are treated at our center. ST of injectable chemotherapy molecules are prepared extemporaneously in our Centralized Cytotoxic Preparation Unit (UPCC). Each series of tests is computerized in the Chimio® software to be integrated into our dematerialized production. In the case of immediate HSR, the series includes prick tests and intradermal tests with successive dilutions; patch tests are added in the case of delayed HSR.
This study aims to evaluate the impact of the ST preparation activity on exploring HSR to injectable chemotherapy molecules within our UPCC.

Method
Between 01/01/2008 and 31/01/2023, a computerized extraction using Chimio^® software and an analysis of Excel^® manufacturing sheets (computerization started during the study period) of prepared ST were carried out.
The type of molecule, the number of ST and preparations series were reported. Demographic and medical data (type of reaction, ST results, and behavior) were collected from the patient medical record (PMR).
The information has been compiled in Microsoft® Excel® 2013.

Results
Of the 96 PMR extracted, 76 had sufficient information to be analyzed.
A total of 136 series of ST (568 preparations) were performed (one patient could receive several series of ST). Of these, 113 were cytotoxic (50 % platinum salts), and 23 were monoclonal antibodies (44 % were Daratumumab and Nivolumab). ST dilution concentrations and the number of dilutions could vary for the same molecule.
Patients aged between 26 and 80 (mean age 60, standard deviation 11.9), primarily women (57.9 %). Of the HSR explored, 63 % were immediate and 29 % delayed (no information in 8 % of cases). Of the 136 ST series, 27 were positive. The contraindication was not maintained in five cases: one reintroduction and four desensitization protocols were implemented without therapeutic alternatives.

Bibliography
1. Leguy-Seguin V, Jolimoy G, Coudert B, Pernot C, Dalac S, Vabres P, et al. Diagnostic and predictive value of skin testing in platinum salt hypersensitivity. J Allergy Clin Immunol. mars 2007;119(3):726‑30.
2. Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, et al. Skin test concentrations for systemically administered drugs — an ENDA/EAACI Drug Allergy Interest Group position paper. Allergy. juin 2013;68(6):702‑12.

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