Schnell-desensibilisierung bei docetaxel-überempfindlichkeit - Fallbericht und übersicht

Background: Hypersensitivity to docetaxel is common and a rush-desensitization regarded as challenging. Case report: A 62-year-old patient presented with a metastasized prostate carcinoma in our department because of an anaphylactic reaction to docetaxel. The patient had received docetaxel i.v. 75 mg/m² body surface. The second infusion had to be stopped due to dyspnea, generalized flush and a hypertensive crisis. A docetaxel hypersensitivity was diagnosed. Skin test revealed negative prick and an irritative reaction after 20 minutes in the intradermal. Due to a lack of treatment alternatives and good clinical response to docetaxel, the indication for docetaxel rush-desensitization was seen. Rush-desensitization would have to be performed for the 9 remaining treatment cycles. After premedication and emergency back-up, the first 2 rush-desensitizations were initiated, following a published 5.8 hours desensitization scheme. Because of good tolerance, later on, this was changed to a modified 4.8 hours scheme. In our patient, this rush-desensitization protocol proved to be safe, fast and effective. Conclusion: In drug-hypersensitivities with a lack of treatment alternatives, rush-desensitization may be an option. If tolerated well, one may try to modify established schemes to gain new experience.