Successful Desensitization in a Child with Carboplatin Allergy: A Case Report

Publisher Website
Google Scholar
Abstract
Hypersensitivity to platinum is described, although its mechanism is unknown. Carboplatin and cisplatin are cytotoxic agents containing platinum. Carboplatin is used to treat childhood tumors. Desensitization to carboplatin has been reported with some protocols requiring more than 3 days duration. We present a 30-month-old Mexican boy with hypothalamic astrocytoma, ventriculoperitoneal (VP) shunt, and hypersensitivity to carboplatin that developed after six courses of treatment. His symptoms included wheezing and mild urticaria. He failed two attempts before successfully completing three desensitizations with the following regimen: hydroxyzine 2 mg/kg/d and prednisolone 4 mg/kg/d begun at 48 hours prior to the carboplatin infusion, ranitidine 2 mg/kg/d at 24 hours. Carboplatin (1 mg/mL) was given at an initial rate of 1 mg/h with increments every 15 minutes (2, 4, 8,16, 32, 40 mg/h). He experienced mild wheezing at 40 mg/h and responded well to steroids, diphenhydramine, and nebulized albuterol. The infusion was resumed at a rate of 32 mg/h to complete 308 mg. The total time of desensitization was 12 hours. Immediate hypersensitivity intradermal testing to carboplatin was positive at 0.01 mg/mL after initial prick testing. This patient responded clinically to premedication according to published anaphylaxis on anaphylactoid desensitization regimens for radiocontrast dyes, which included corticosteroids, a combination of HI and H2 antagonists, and ephedrine, but he continued to have dose-dependent reactions. Dose-dependent reactions may reflect both anaphylactoid and IgE-mediated reactivity in our patient. Desensitization to carboplatin requires monitoring in a controlled environment and careful attention at each infusion because tolerance to previous regimens may not predict response to subsequent infusions.