{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:34:29Z","timestamp":1787506469283,"version":"build-2736575974"},"reference-count":26,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Methods and protocols"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["MPs"],"abstract":"<jats:p>Background: Hypersensitivity reactions to antineoplastic agents are an increasing clinical challenge due to their rising incidence and potential severity. Early allergological assessment and tailored drug re-exposure strategies may allow continuation of essential therapies, although real-world data remain limited. Methods: We conducted a monocentric retrospective observational study including adult oncologic patients with suspected chemotherapy-induced hypersensitivity reactions. Clinical features, allergological work-up, and management strategies were analyzed. The primary outcome was the success rate of drug reintroduction using desensitization or enhanced premedication. Secondary outcomes included skin test positivity rates and the association between cumulative chemotherapy exposure and anaphylaxis. Results: Forty-two patients were included (95% female; median age 57.5 years). Re-exposure was required in 18 patients, and was successful in all patients undergoing desensitization and in 92% of those managed with enhanced premedication. Skin testing was positive in 71% of suspected platinum reactions, 30% of taxanes, and 40% of biologic agent reactions. Anaphylaxis occurred in 26.2% of patients, and a trend toward an association with cumulative chemotherapy exposure was observed; each additional cycle was associated with a 28% increase in the odds of anaphylaxis (adjusted OR 1.28; 95% CI, 1.00\u20131.63). Conclusions: Desensitization and enhanced premedication allow safe reintroduction of antineoplastic agents. Cumulative chemotherapy exposure is associated with an increased risk of anaphylaxis.<\/jats:p>","DOI":"10.3390\/mps9020056","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T11:51:03Z","timestamp":1775130663000},"page":"56","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Management of Patients with Suspected Hypersensitivity to Chemotherapy Drugs: A Practical Approach in a Tertiary Care Setting"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3677-4342","authenticated-orcid":false,"given":"Maria Bernadette","family":"Cilona","sequence":"first","affiliation":[{"name":"Multidisciplinary Advanced Center of Asthma, Food and Drug Allergy, IRCCS San Raffaele Hospital, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3560-9759","authenticated-orcid":false,"given":"Serena","family":"Nannipieri","sequence":"additional","affiliation":[{"name":"Multidisciplinary Advanced Center of Asthma, Food and Drug Allergy, IRCCS San Raffaele Hospital, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Ferlito","sequence":"additional","affiliation":[{"name":"Multidisciplinary Advanced Center of Asthma, Food and Drug Allergy, IRCCS San Raffaele Hospital, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Orsi","sequence":"additional","affiliation":[{"name":"Oncology Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Ronzoni","sequence":"additional","affiliation":[{"name":"Unit of Oncology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8451-429X","authenticated-orcid":false,"given":"Giorgia","family":"Mangili","sequence":"additional","affiliation":[{"name":"Unit of Gynecology and Obstetrics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Rabaiotti","sequence":"additional","affiliation":[{"name":"Unit of Gynecology and Obstetrics, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Ciceri","sequence":"additional","affiliation":[{"name":"Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6463-0293","authenticated-orcid":false,"given":"Michele","family":"Reni","sequence":"additional","affiliation":[{"name":"Oncology Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2417-0410","authenticated-orcid":false,"given":"Mona-Rita","family":"Yacoub","sequence":"additional","affiliation":[{"name":"Multidisciplinary Advanced Center of Asthma, Food and Drug Allergy, IRCCS San Raffaele Hospital, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1111\/all.15113","article-title":"Hypersensitivity reactions to chemotherapy: An EAACI Position Paper","volume":"77","author":"Pagani","year":"2022","journal-title":"Allergy"},{"key":"ref_2","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1016\/j.jaip.2019.12.032","article-title":"Allergy Evaluation of Hypersensitivity to Platinum Salts and Taxanes: A Six-Year Experience","volume":"8","author":"Pradelli","year":"2020","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_4","first-page":"44","article-title":"Mechanisms of hypersensitivity reactions induced by drugs","volume":"90","author":"Franceschini","year":"2019","journal-title":"Acta Biomed."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.jaip.2020.08.002","article-title":"Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: General Concepts","volume":"8","author":"Broyles","year":"2020","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/j.jaip.2025.02.042","article-title":"New Approaches to Chemotherapeutic Drug Allergy: From Drug Challenge to Desensitization","volume":"13","author":"Banerji","year":"2025","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1007\/s12016-022-08932-2","article-title":"Premedication Protocols to Prevent Hypersensitivity Reactions to Chemotherapy: A Literature Review","volume":"62","author":"ALMuhizi","year":"2022","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s12016-014-8416-0","article-title":"Re-visiting Hypersensitivity Reactions to Taxanes: A Comprehensive Review","volume":"49","author":"Picard","year":"2015","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2851","DOI":"10.1111\/all.15889","article-title":"Nomenclature of allergic diseases and hypersensitivity reactions: Adapted to modern needs: An EAACI position paper","volume":"78","author":"Jutel","year":"2023","journal-title":"Allergy"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Werner-Busse, A., and Zuberbier, T. (2014). The allergic emergency--management of severe allergic reactions. J. Dtsch. Dermatol. Ges., 12.","DOI":"10.1111\/ddg.12309"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"100472","DOI":"10.1016\/j.waojou.2020.100472","article-title":"World allergy organization anaphylaxis guidance 2020","volume":"13","author":"Cardona","year":"2020","journal-title":"World Allergy Organ. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1111\/all.15996","article-title":"EAACI\/ENDA position paper on drug provocation testing","volume":"79","author":"Barbaud","year":"2024","journal-title":"Allergy"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.anai.2025.07.018","article-title":"Update on desensitization to chemotherapeutics and biologicals","volume":"135","author":"Caiado","year":"2025","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"67","DOI":"10.4103\/aca.ACA_157_18","article-title":"Descriptive statistics and normality tests for statistical data","volume":"22","author":"Mishra","year":"2019","journal-title":"Ann. Card. Anaesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1002\/(SICI)1097-0258(19990615)18:11<1387::AID-SIM126>3.0.CO;2-V","article-title":"Use of the Mann-Whitney U-test for clustered data","volume":"18","author":"Rosner","year":"1999","journal-title":"Stat. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.1007\/s00432-018-2753-y","article-title":"Impact of carboplatin hypersensitivity and desensitization on patients with recurrent ovarian cancer","volume":"144","author":"Altwerger","year":"2018","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.ygyno.2018.10.037","article-title":"Outpatient desensitization of patients with moderate (high-risk) to severe platinum hypersensitivity reactions","volume":"152","author":"Vetter","year":"2019","journal-title":"Gynecol. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"100640","DOI":"10.1016\/j.waojou.2022.100640","article-title":"Standards for practical intravenous rapid drug desensitization & delabeling: A WAO committee statement","volume":"15","year":"2022","journal-title":"World Allergy Organ. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.anai.2023.05.010","article-title":"Knowledge gaps in the diagnosis and management of anaphylaxis","volume":"131","author":"Wallace","year":"2023","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1007\/s12016-021-08877-y","article-title":"Hypersensitivity Reactions to Platinum Agents and Taxanes","volume":"62","author":"Tsao","year":"2022","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1177\/10781552211050084","article-title":"Comparative Assessment of Platinum Salts and Taxane Group Hypersensitivity Reactions, The Role of Skin Tests in Diagnosis?","volume":"28","author":"Ayhan","year":"2022","journal-title":"J. Oncol. Pharm. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Longhino, D., and Sarnari, C. (2025). Allergy evaluation in hypersensitivity to platinum compounds and taxanes: A 5-year experience. Eur. Ann. Allergy Clin. Immunol., 10.","DOI":"10.23822\/EurAnnACI.1764-1489.389"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1016\/j.jaip.2024.02.019","article-title":"Non-IgE-Mediated Immediate Drug-Induced Hypersensitivity Reactions","volume":"12","author":"Kumar","year":"2024","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"207084","DOI":"10.1155\/2010\/207084","article-title":"Hypersensitivity reactions associated with platinum antineoplastic agents: A systematic review","volume":"2010","author":"Makrilia","year":"2010","journal-title":"Met. Based Drugs"},{"key":"ref_25","first-page":"333","article-title":"Correlation between atopy and hypersensitivity reactions during therapy with three different TNF-alpha blocking agents in rheumatoid arthritis","volume":"27","author":"Benucci","year":"2009","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1159\/000324454","article-title":"Hypersensitivity reactions to docetaxel: Retrospective evaluation and development of a desensitization protocol","volume":"156","author":"Syrigou","year":"2011","journal-title":"Int. Arch. Allergy Immunol."}],"container-title":["Methods and Protocols"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2409-9279\/9\/2\/56\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T12:20:10Z","timestamp":1775132410000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2409-9279\/9\/2\/56"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,2]]},"references-count":26,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["mps9020056"],"URL":"https:\/\/doi.org\/10.3390\/mps9020056","relation":{},"ISSN":["2409-9279"],"issn-type":[{"value":"2409-9279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,2]]}}}