J ALLERGY CLIN IMMUNOL

FEBRUARY 2014

AB152 Abstracts

SUNDAY

531 Safety Of Propofol Use In Patients With Food AllergiesDr. Harshna Mehta, MD1, Dr. Mirna Chehade, MD, MPH2;

1The Icahn School of Medicine at Mount Sinai, New York, NY, 2Icahn

School of Medicine at Mount Sinai, New York, NY; Mount Sinai Center

of Eosinophilic Disorders, Jaffe Food Allergy Institute, Mount Sinai

School of Medicine, New York, NY.

RATIONALE: Propofol (2,6-diisopropylphenol) is a commonly used

intravenous drug for induction and maintenance of anesthesia during

endoscopic procedures. The drug, though generally considered safe, has

been considered a relative contraindication in egg and soy allergic patients.

Our aim was to determine whether patients with evidence of food allergy,

particularly to egg, soy and/or peanut had an allergic reaction to propofol

when used during their endoscopies.

METHODS: Records of 100 patients that had endoscopies performed at

the Mount Sinai Center of Eosinophilic Disorders were reviewed. Egg,

peanut and soy allergy was confirmed based on finding elevated food-

specific serum IgE levels, positive skin prick tests and/or convincing

allergic reaction history. Patients were included if anesthesia records

indicated propofol as the main anesthetic administered.

RESULTS: 45patients (meanage513.2years, range52-64)were identified

with one or more food allergies, which included 6 patients with history of

anaphylaxis. Of those, 16 patients had evidence of egg allergy (median egg-

IgE516.2 kIU/L, range50.8-100). Two of these patients had history of

anaphylaxis to egg. Of the 10 patients with confirmed soy allergy, 6 had

serum soy-IgE levels obtained (median soy-IgE58.5 kIU/L, range53.6-

100). Fourteen patients had peanut allergy (median peanut-IgE5100 kIU/L,

range50.35-100). Three of these patients had history of anaphylaxis to

peanut. There were no reported reactions to propofol in any of the patients.

CONCLUSIONS: In this food allergic population undergoing endos-

copies under anesthesia with propofol, no allergic reactions to propofol

were seen. Propofol (2,6-diisopropylphenol) can be considered generally

safe for use in patients with history of severe food allergies.

532 Risk Stratification Protocol For Carboplatin and OxaliplatinHypersensitivity Reactions With Repeat Skin TestingImproves Care

Dr. Alberta L.Wang,MD1, Dr. Sarita U. Patil, MD2, Dr. Aidan Long, MD,

FAAAAI2, Dr. Aleena Banerji, MD2; 1Department of Medicine, Massachu-

setts General Hospital, Harvard Medical School, Boston, MA, 2Division of

Rheumatology, Allergy, and Immunology, Department of Medicine, Massa-

chusetts General Hospital, Harvard Medical School, Boston, MA.

RATIONALE: A risk stratification protocol utilizing repeat skin testing

(ST) was previously published in a small number of patients with

carboplatin hypersensitivity reactions (HSRs). We studied this strategy

in a larger number of patients with carboplatin or oxaliplatin HSR.

METHODS: In a 5-year retrospective review, patients referred to Allergy/

Immunology with carboplatin or oxaliplatin HSR were treated with a risk

stratification protocol using 3 repeat STs with intervening desensitizations.

If repeat ST remained negative three times, patients received subsequent

infusions without desensitization.

RESULTS: From 2008-2012, 144 patients (92 carboplatin, 52 oxaliplatin)

completed 577 desensitizations. Carboplatin HSR patients were classified as

ST positive (n532), negative (n537), or converters (n523) when initial

negative ST converted to positive on repeat ST. ST positive patients had

more severe initial HSR than ST negative patients (p<0.05). Of the 52 oxa-

liplatin patients, 22 were ST positive, 25 were ST negative, 3 were ST con-

verters, and 2 did not receive ST. For both carboplatin and oxaliplatin, ST

converters had a longer time interval between HSR and initial ST compared

to ST positive patients (carboplatin median 42 (IQR 2-96) vs 3 (IQR 2-8)

weeks, oxaliplatin median 78 (IQR 40-92) vs 3 (IQR 1-5) weeks, p<0.05).Twenty-two carboplatin and 18 oxaliplatin HSR patients remained ST nega-

tive after three serial STs with intervening desensitizatons, and the majority

(82% and 89%, respectively) completed their chemotherapy regimens as

outpatient infusions without desensitizations.

CONCLUSIONS: Repeat STs improve care for patients with carboplatin

or oxaliplatin HSR. Our novel risk stratification protocol identifies patients

that can receive infusions without desensitization.

533 Added Value Of Skin Testing In Hypersensitivity Reactions ToTaxanes

Dr. Matthieu Picard, MD1, Dr. Leyla Pur, MD1, Dr. Joana Caiado, MD1,

Prof. Pedro Giavina-Bianchi, MD, PhD, FAAAAI2, Dr. Violeta

Galv~ao, MD1, Dr. Mariana C. Castells, MD, PhD, FAAAAI1; 1Division of

Rheumatology, Allergy and Immunology, Department of Medicine, Brigham

and Women’s Hospital, Harvard Medical School, Boston, MA, 2Clinical Im-

unnology and Allergy Division, University of Sao Paulo, Boston, MA.

RATIONALE: Taxanes hypersensitivity reactions (HSRs) occur in 1-10

% of ovarian cancer patients treated with these drugs and can be

anaphylactic precluding their re-adminsitration. Desensitization has pro-

vided a treatment option for these patients but the mechanisms of taxane

hypersensitivity have not been elucidated. Skin testing (ST) was recently

introduced in the evaluation of these patients and we sought to determine

its value in the management of taxane HSRs.

METHODS: We reviewed the skin test results of all patients undergoing

desensitization or challenge to taxanes between 01/2012 and 06/2013.

RESULTS: Seventy-one patients reported a total of 87HSRs (57 immediate

and 30 delayed; 73 to paclitaxel and 14 to docetaxel). Paclitaxel ST was

performed on 64 patients and was positive (+) in 44/56 patients (79%) with a

paclitaxel HSR, in 3/6 (50%) with a docetaxel HSR and in 2/2 (100%) with

HSRs to both. Fifteen patients had negative (-) paclitaxel STand one of them

was ST+ to docetaxel. Eleven ST- patients with a delayed or mild to

moderate immediate HSR to paclitaxel were challenged. All tolerated the

procedure and resumed regular infusions. One patient had a recurrent HSR

and was found to have converted from ST- to ST+. Sixty-two patients (50

ST+, 4 ST-, 1 ST converter and 7 not ST) underwent a total of 471

desensitizations. Mild HSRs occurred in 8% of all desensitizations.

CONCLUSIONS: Taxane ST can identify patients with immediate and

delayed HSRs who can safely undergo a challenge (ST- with a non-severe

initial HSR) and, if successful, resume regular infusions.

534 Risk Stratification For Paclitaxel-Induced HypersensitivityReactions Improves Quality Of Care

Dr. Timothy P. Lax, MD, Dr. Aleena Banerji, MD, Dr. Johnson T.

Wong, MD, FAAAAI, Dr. Michael T. Wilson, MD, PhD, Dr. Aidan

Long, MD, FAAAAI; Division of Rheumatology, Allergy, and Immu-

nology, Department of Medicine, Massachusetts General Hospital, Har-

vard Medical School, Boston, MA.

RATIONALE: Paclitaxel-induced hypersensitivity reactions (HSRs)

limit its use in standard therapy. While desensitization is a successful

strategy, evidence-based risk stratification can improve quality of care.

METHODS: We performed a retrospective review of all paclitaxel-

induced HSRs referred to Allergy/Immunology between 2010 and 2013.

The initial HSR and clinical outcomes were reviewed and graded. Utilizing

these results, a risk stratification strategy was developed to improve quality

of care for patients with paclitaxel-induced HSRs.

RESULTS: We identified 23 patients with paclitaxel-induced HSRs who

underwent desensitization. Initial HSRs were sub-divided into grade 1

(N57), grade 2 (N59), and grade 3/4 (N57). 28% (N52) of initial grade 1

and 55% (N55) initial grade 2 patients experienced HSRs (six grade 1, one

grade 2 HSRs) during desensitization compared to 86% (N56) of initial

grade 3/4 patients. Paclitaxel was advanced to 50% of the standard rate

without desensitization in four patients (three initial grade 1, one initial

grade 2). All four patients tolerated the infusions and returned to the

outpatient setting. Based on these findings, a risk stratification protocol was

implemented. Grade 1 initial HSR are infused at 50% of the standard rate

while grade 2 and grade 3/4 HSR are administered paclitaxel utilizing 8-

and 12-step desensitization protocols respectively. All five patients studied

to date using this risk stratification tolerated re-treatment safely including 2

patients with initial grade 1 HSR administered paclitaxel without

desensitization.

CONCLUSIONS: Our risk stratification strategy for paclitaxel-induced

HSRs improves quality of care and allows patients to safely receive

paclitaxel while reducing the number of unnecessary desensitizations.