Rapid drug desensitization to taxanes: a descriptive study from Turkey.

AIM: To present the characteristics of drug hypersensitivity reactions (DHRs) among taxane recipients with non-small cell lung carcinoma (NSCLC), and to describe the results of rapid drug desensitization (RDD). METHODS: A retrospective cross-sectional study included 45 patients who were treated with taxane for NSCLC and were found to be hypersensitive to taxane. All patients were administered the standard 3-bag, 12-step RDD protocol following the development of DHR. RDD success was evaluated separately for each cycle, and successful RDD was defined as the completion of the cycle with application of 12 steps of the desensitization protocol and the absence of early and/or late reactions afterwards. RESULTS: Among 45 patients hypersensitive to taxane 43 (95.6%) successfully received taxane cycles with desensitization. Failed RDD occurred in only 2 (4.4%) patients. The total number of desensitization cycles was 183, of which 181 (98.9%) were successful. The mean age of patients with successful desensitization was 59.42 ± 10.48 years and 37 (86.0%) of them were male. CONCLUSION: RDD is a reliable procedure that enables effective administration and completion of first-line taxane treatments in taxane-sensitive patients.

Platin desensitizations in thoracic malignancies and risk factors for breakthrough reactions.

Although platin desensitization is a safe and effective alternative for patients with hypersensitivity reactions (HSRs), sometimes breakthrough reactions (BTRs) can be encountered. However, data about the risk factors for BTRs are limited. The aim of this study is to define the outcomes of desensitization, the characteristics of BTRs, and to identify the risk factors for BTRs with platins in thoracic malignancies. This is a retrospective report of patients with thoracic malignancies who underwent platin desensitization. Patients' demographics, initial HSR characteristics, skin test results, desensitization outcomes, and BTR characteristics were recorded. Thirty-three lung cancer and 14 malignant pleural mesothelioma (MPM) patients were included in the study. The culprit drug was cisplatin in 29 and was carboplatin in 18 patients. Skin test positivity was 43.5% with cisplatin, 50% with carboplatin, and it was found to be higher if the interval between the initial HSR and skin testing (ST) was ˃20 days (p = 0.027). One hundred and five desensitization courses were performed. Twenty-two patients had 33 BTRs. Skin test positivity was higher in the BTR-positive group (p = 0.025). BTRs (18.2%; n = 6) were more severe than initial HSR. In the case of epinephrine administration during initial HSR, epinephrine administration during the first BTR was found to be more (p = 0.036). The target dose was achieved in 92.4% of desensitization courses. The number of previous platin infusions ≥10 was found to be an independent risk factor for BTR development (p = 0.036 OR:17.641, 95% CI: 1.211-256.971). Identification of risk factors for BTR will guide appropriate management and desensitization approaches for platin HSRs.

Successful desensitization under antihistamine suppression in a case with urticaria due to osimertinib.

INTRODUCTION: Osimertinib is an approved therapy for patients with a Thr790met (T790M) mutation diagnosed with non-small cell lung cancer (NSCLC) that progresses during epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy. However, in 7-13% of patients, drug-related side effects lead to discontinuation of osimertinib treatment. In such cases, osimertinib desensitization is a treatment option that can be considered. CASE REPORT: A 59-year-old female patient, who was followed up with the diagnosis of stage 4 NSCLC, was consulted to the allergy clinic because of urticaria. The patient developed urticaria plaques 20 h after the third dose of osimertinib tablet. MANAGEMENT & OUTCOME: With the diagnosis of osimertinib-induced urticaria, desensitization was planned for the patient. Treatment was started with a dose of 0.1 mg/day osimertinib. The procedure was completed in approximately 50 days, and a dose of 80 mg/day was reached with antihistamine suppression. DISCUSSION: Here, a successful osimertinib desensitization in a patient with a history of osimertinib-related type 1 allergic reaction is reported. Osimertinib desensitization is a treatment option that should be considered in cases where treatment has to be ceased due to drug-related side effects.

[The prevalence of chronic bronchitis in adults living in the center of Gumushane]. / Gümüshane il merkezinde yasayan eriskinlerde kronik bronsit prevalansi

INTRODUCTION: Chronic bronchitis and emphysema are major components of chronic obstructive pulmonary diseases (COPD). The aim of this study was to determine the prevalence of chronic bronchitis 20 years and over living in the center of Gumushane and to analyze the risk factors. MATERIALS AND METHODS: The study is targeted to reach 373 people who represent the center of Gumushane, 368 (98.6%) people have been reached. Participants were filled modified version of the questionnaire created by the Medical Research Council by face-to-face interview technique. RESULTS: The prevalence of chronic bronchitis was 14.1%. The average age was in the chronic bronchitis group and non-chronic bronchitis group was respectively 43.2 ± 12.9, 39.3 ± 11.6, and the differance was statistically significant (p< 0.05). Considering the relationship between cigarette smoking with chronic bronchitis, it was more frequent in smokers than non-smokers (p< 0.001, OR 4.74, 95% CI 2.47-9.17). Chronic bronchitis was observed in passive smokers than in non-smokers (p= 0.004, OR 2.86, 95% CI 1.36-6.03). Occupational exposure to dust, fumes and history of childhood pulmonary diseases were increased chronic bronchitis prevalence (respectively, p< 0.001, OR 9.53, 95% CI 4.56-19.94; p< 0.001, OR 12.14, 95% CI 5.87-25.12). Male gender, low income level and to warm up with stove were found statistically significant by univariate logistic regression analysis but these risk factors were not statistically significant in the multivariate analysis. Educational level was not found statistically significant in both analysis (p> 0.05). CONCLUSION: The prevalence of chronic bronchitis was 14.1% in 20 years and older adults living in the center of Gumushane. Old age (especially over the age of 50), active or passive smoking, occupational history of dust, fumes and history of childhood pulmonary diseases were found to be risk factors for chronic bronchitis.