Fatal outcome of a hypersensitivity reaction to paclitaxel: a critical review of premedication regimens

• Published in: British journal of cancer Vol. 90; no. 2; pp. 304 - 305
• Main Authors: KLOOVER, J. S, DEN BAKKER, M. A, GELDERBLOM, H, VAN MEERBEECK, J. P
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 26-01-2004
• Subjects: Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - therapeutic use; Antineoplastic Agents, Phytogenic - adverse effects; Antineoplastic Agents, Phytogenic - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - drug therapy; Clemastine - administration & dosage; Clemastine - therapeutic use; Dexamethasone - administration & dosage; Dexamethasone - therapeutic use; Drug Hypersensitivity - prevention & control; Fatal Outcome; Histamine H1 Antagonists - administration & dosage; Histamine H1 Antagonists - therapeutic use; Histamine H2 Antagonists - administration & dosage; Histamine H2 Antagonists - therapeutic use; Humans; Infusions, Intravenous; Lung Neoplasms - drug therapy; Male; Medical sciences; Middle Aged; Paclitaxel - adverse effects; Paclitaxel - therapeutic use; Ranitidine - administration & dosage; Ranitidine - therapeutic use; Risk Factors; Short Communication; Tumors; Antineoplastic agent; Corticosteroid; Immunopathology; Allergy; Dexamethasone; Prognosis; Steroid hormone; Hypersensitivity; Antiinflammatory agent; premeditation; Anaphylaxis; Cancerology; hypersensitivity reaction; Taxane derivatives; Paclitaxel; Antimitotic; Bibliographic review
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/sj.bjc.6601303

Hypersensitivity reactions (HSRs) to paclitaxel are frequently encountered in patients receiving this antitumour drug. Administration of histamine H1- and H2-receptor antagonists and corticosteroids has been shown to reduce significantly the risk of developing an HSR in patients receiving taxanes. In this case report, we describe the fatal outcome of an HSR in a patient receiving paclitaxel despite short-course premedication. The level of evidence supporting the short-course i.v. premedication schedule is challenged, as it is not compatible with the pharmacokinetic properties of dexamethasone.