Allergies to chemotherapy are rare, but the incidence has been increasing over the past few years. The most common chemotherapeutic agents to cause allergic reactions are those used to treat ovarian, breast, prostate, and gastrointestinal cancers. These include carboplatin, cisplatin, oxaliplatin, paclitaxel, and docetaxel. With carboplatin, the chance of experiencing an allergic reaction increases after receiving 7 – 8 cycles.
When patients cannot tolerate these medications, they are often switched to another drug that may not be as effective in treating their cancer. However, patients can safely receive the best chemotherapy for them, even if they are allergic to it, through a process called desensitization. Desensitization involves the administration of increasing amounts of the medication over a longer period of time, starting at a very low dose. This is done by diluting the medication into multiple “bags,” with the first bag having the lowest amount of drug and the final bag having the highest amount of the drug. These bags are infused over 5 – 6 hours, in order for the patient’s body to “get used to” the chemotherapy. Our goal at Windom Allergy is to allow cancer patients with allergic reactions to chemotherapy to resume treatment with their doctor’s drug of choice and not have to switch to a second line therapy.
Biologic agents are cutting edge medications that are used to treat a variety of diseases, including rheumatologic conditions, cancer, asthma, allergies, neurologic conditions, and inflammatory bowel disease. Allergic reactions to biologics are uncommon but occur more frequently than chemotherapy reactions. The most common biologic agents to cause allergic reactions include rituximab (Rituxan), trastuzumab (Herceptin) tocilizumab, cetuximab (Erbitux, especially in the setting of alpha-gal syndrome), infliximab (Remicade), and omalizumab (Xolair). Patients can be safely desensitized to these medications in order to receive the best treatment possible.
Desensitizations to medications should only be performed under the guidance of a knowledgeable Allergist/Immunologist. Although there are several protocols that have been used to desensitize patients to chemotherapy and biologics, the method that has been shown to be the safest in multiple publications has been the “Castells Method.” This was developed by Dr. Mariana Castells at Brigham & Women/Harvard. Dr. Castells has performed thousands of desensitizations at the Dana-Farber Cancer Institute with an estimated 98% success rate with no fatalities during desensitization and only minor reactions that are easily treated during the process. Our Dr. Tara Saco received a portion of her fellowship training from Dr. Castells and is one of the few Allergists in the state of Florida experienced with this desensitization technique.
Other medications that patients can be desensitized to include IV iron (for patients with severe anemia), progesterone (for patients with endometrial cancer, on birth control, experiencing anaphylaxis to their own natural progesterone during their menstrual cycle, and women undergoing in-vitro fertilization treatments), aspirin, antibiotics (e.g. penicillin - to see more on drug allergies, click here), and many others.
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