Anaphylactic Reaction Induced By Paclitaxel in the Treatment of Non-Small Cell Lung Cancer (NSCLC)

Most systemic chemotherapic agents used in lung cancer treatment can lead to hypersensitivity reactions, of varying degrees of severity. In absence of laboratory tests (such as elevated serum total tryptase or/and plasma histamine levels).Distinguishing between anaphylaxis and acute infusion reactions is impossible since their symptoms are identical. Few Paclitaxel hypersensitivity reactions described in literature are documented in the absence of standardized tests to chemotherapeutics drugs and since not all suspected patients undergo allergological tests. A 74 years old female patient, with history of Inobitriol induced laryngeal angioedema and right middle lobe NSCLC, developed a moderate anaphylactic reaction during Paclitaxel second administration. Infusion suspension and symptomatic treatments led to rapid symptoms remission. Prick tests to Paclitaxel were negatives but the intradermal reaction was positive, as well as basophile activation test. The mechanism of paclitaxel-associated hypersensitivity reaction is uncertain and its solvent vehicle may be involved; in case of paclitaxel immediate hypersensitivity reaction, we recommend tryptase and/or histamine serum levels quantification to confirm the acute anaphylaxis episode and realization of allergologicals tests to Paclitaxel and its solvent vehicle (skin tests ± challenge test) 3 to 4 weeks after the incident. Rapid desensitization is possible for both Ig-E mediated and non-Ig-E mediated immediate hypersensitivity reactions to Paclitaxel.