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Premedication Protocols to Prevent Hypersensitivity Reactions to Chemotherapy: a Literature Review

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Abstract

Hypersensitivity reactions (HSRs) to chemotherapy may prevent patients from receiving the most effective therapy. This review was undertaken to identify evidence-based preventive premedication strategies that reduce the likelihood of HSR in the first instance and improve the safety of subsequent infusions in patients who have demonstrated HSR to a certain class of chemotherapy. PubMed was searched until October 2021 using the key words: “hypersensitivity to chemotherapeutic drugs,” “hypersensitivity to antineoplastic agents,” “taxanes hypersensitivity,” “platinum compound hypersensitivity,” “premedication,” “dexamethasone,” “prednisone,” “hydrocortisone,” “antihistamine,” “diphenhydramine,” “cetirizine,” “famotidine,” “meperidine,” “aspirin,” “ibuprofen,” and “montelukast.” The search was restricted to articles published in English. A total of 73 abstracts were selected for inclusion in the review. Most premedication regimens have been derived empirically rather than determined through randomized trials. Based on the available evidence, we provide an update on likely HSR mechanisms and a practical guide for classifying systemic HSR. The evidence indicates that a combination of prevention strategies using newer antihistamines, H2 antagonists, leukotriene receptor antagonists, and corticosteroids and other interventions used judiciously reduces the occurrence and severity of HSR and improves safety.

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Authors and Affiliations

  1. Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre (MUHC), McGill University, Montreal, QC, Canada

    ALMuhizi Faisal, Ana M. Copaescu & Ghislaine A. C. Isabwe

  2. Division of Allergy and Clinical Immunology, Department of Internal Medicine, Security Forces Hospital Program, Riyadh, Saudi Arabia

    ALMuhizi Faisal

  3. Department of Allergy, La Paz University Hospital, Madrid, Spain

    Leticia De Las Vecillas Sanchez

  4. Department of Oncology, Obstetrics and Gynecology, McGill University Health Center (MUHC), McGill University, Montreal, QC, Canada

    Lucy Gilbert

  5. The Research Institute, McGill University Health Centre, McGill University, Montreal, QC, Canada

    Ana M. Copaescu & Ghislaine A. C. Isabwe

  6. Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia

    Ana M. Copaescu

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Ghislaine Isabwe suggested the article`s idea, Faisal ALMuhizi performed the literature search, analyzed the data, and drafted the work. All the authors critically revised the manuscript and made a substantial, direct, and intellectual contribution to the work. All the authors approved the manuscript for publication.

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Correspondence to Ghislaine A. C. Isabwe.

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ALMuhizi, F., De Las Vecillas Sanchez, L., Gilbert, L. et al. Premedication Protocols to Prevent Hypersensitivity Reactions to Chemotherapy: a Literature Review. Clinic Rev Allerg Immunol 62, 534–547 (2022). https://doi.org/10.1007/s12016-022-08932-2

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