Evaluation of the basophil activation in immediate type hypersensitivity reactions to chemotherapeutic agents

Introduction:
Revealing the responsible mechanisms of hypersensitivity reactions (HSRs) to chemotherapeutics may guide the prevention of these reactions and provide re-use of the responsible drug.

Aim:
This study aims to evaluate the role of basophils during the immediate-type HSRs and desensitization to culprit chemotherapeutics.

Material and methods:
Twenty patients were included in the study. Peripheral whole blood samples were obtained from patients immediately after the reaction and pre- and post- desensitization procedures in the next cycle. Basophil activation was assessed by flow cytometry. A stimulation index (SI) was calculated by proportioning the values at the time of reaction and post-desensitization to the pre-desensitization values.

Results:
Desensitization with the culprit chemotherapeutic was performed in 14 of 20 patients. The culprit drug was cisplatin in 4 patients, taxanes in 5 and etoposide in 5 patients. In patients who had HSRs to cisplatin and etoposide (except one with etoposide hypersensitivity), reaction time SI was greater than 2, indicating basophil activation. In a patient who had a breakthrough reaction to cisplatin during desensitization, basophil activation was also detected at the time of this reaction. None of the patients with taxane hypersensitivity reaction showed basophil activation at the time of the reaction. Post-desensitization basophil activation was not detected in any patient. There was a significant tryptase increment during the index reaction in all cisplatin patients, only one taxane patient, and during the breakthrough reaction to cisplatin.

Conclusions:
Basophil activation has been shown to play a role in the mechanism of immediate-type HSRs to cisplatin and etoposide. Desensitization procedures in this group of patients prevent basophil activation and ensure the safe use of the drug.