Abstract：
Taxanes in the treatment of cancer are associated with a significant incidence of hypersensitivity reactions, which may preclude their use in patients in need of first line therapy. Drug desensitization induces transient immunological tolerance and has allowed the reintroduction of taxanes in highly allergic patients. Increase the knowledge of hypersensitivity reactions (HSR) during the administration of taxanes. A systematic review regarding the safety and efficacy of rapid drug desensitization (RDD) for taxanes HSR. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was registered in PROSPERO(CRD42021242324) and a comprehensive search was conducted in Medline, Embase, Web of Science and Scopus databases. 25 studies encompassing 10 countries were identified and 976 patients with initial HSR to paclitaxel (n = 707) and docetaxel (n = 284), that underwent a total of 2,396 desensitizations. The most common symptoms were cutaneous (74.6%) with paclitaxel and respiratory (72.6%) with docetaxel. Severe initial hypersensitivity reactions including anaphylaxis occurred in 39.6% and 13% of paclitaxel and docetaxel cases respectively and during the first (87.4%) or second exposure (81.5%). Patients tolerated well RDD and breakthrough reactions (BTR) occurred in 32.2% of paclitaxel-treated patients and in 20.6% of docetaxel treated patients. Premedications included corticosteroids, antihistamines and leukotriene receptor antagonists. The most commonly used protocol was the BWH 3 bags 12 steps, all protocols showed a success rate between 95-100%, with no reported deaths. RDD is a safe and effective procedure in patients with HSR to taxanes and protocols should be standardized for wide range implementation.
摘要：
紫杉烷类在癌症治疗中与超敏反应的显著发生率相关，这可能会阻止他们在需要一线治疗的患者中使用。药物脱敏可诱导短暂的免疫耐受，并允许紫杉烷类药物在高度过敏的患者中重新引入。增加紫杉烷类药物给药过程中过敏反应（HSR）的知识。关于紫杉烷HSR快速药物脱敏（RDD）的安全性和有效性的系统评价。该研究遵循了系统评价和荟萃分析(PRISMA)指南的首选报告项目，在PROSPERO（CRD42021242324）注册，并在Medline进行了全面搜索，Embase,WebofScience和Scopus数据库。确定了25项研究，涵盖了10个国家，976例初始HSR患者接受紫杉醇（n=707）和多西他赛（n=284），总共进行了2396次脱敏。最常见的症状是紫杉醇的皮肤（74.6％）和多西他赛的呼吸（72.6％）。严重的初始超敏反应，包括过敏反应分别发生在39.6％和13％的紫杉醇和多西他赛病例中，以及第一次（87.4％）或第二次（81.5％）暴露期间。32.2％的紫杉醇治疗患者和20.6％的多西他赛治疗患者对RDD和突破反应（BTR）的耐受性良好。前用药包括皮质类固醇，抗组胺药和白三烯受体拮抗剂。最常用的方案是BWH3袋12个步骤，所有方案的成功率都在95-100%之间，没有死亡报告。RDD是紫杉烷类HSR患者的安全有效程序，应将方案标准化以广泛实施。
