Management of hypersensitivity reactions to platinum drugs using rapid desensitization : Personalized diagnosis, improved safety and efficacy

Os antineoplásicos do grupo das platinas são fármacos essenciais no tratamento da neoplasia do ovário e cólon, e o seu uso continuado/recorrente tem sido associado ao aumento global de reacções de hipersensibilidade (RHS). As RHS podem conduzir à suspensão de terapêuticas críticas, condicionando a sobrevivência de doentes oncológicos. Os testes cutâneos, considerados gold-standard na identificação de sensibilização às platinas, têm sido associados à ocorrência de reacções irritativas locais e risco de contaminação de profissionais de saúde. Investigámos assim o desempenho de testes diagnósticos in vitro/ex vivo que pudessem ser utilizados como complemento/alternativa aos testes cutâneos, em doentes com RHS a platinas. Demonstrámos que a determinação de IgE-específicas (IgE-esp) séricas para platinas é promissora não apenas no diagnóstico, como também na avaliação de reactividade cruzada entre as platinas. A maioria dos doentes sensibilizados à oxaliplatina tinha IgE-esp detectáveis não só para a oxaliplatina, mas também para a carboplatina e cisplatina, apresentando assim, provavelmente, maior risco de RHS a outras platinas. Mostrámos também a elevada sensibilidade do Teste de Activação de Basófilos no diagnóstico de RHS à oxaliplatina, quando utilizado o marcador de activação basofílica CD203c, não tendo o CD63 atingido significado estatístico. Demonstrámos ainda que, na ausência de alternativas terapêuticas igualmente eficazes, a dessensibilização rápida a platinas permite a sua reintrodução eficaz e segura, mesmo quando realizada totalmente em regime de ambulatório. Identificámos também que, na nossa série, níveis elevados de IgE total sérica estão associados de forma independente a maior risco de RHS durante a dessensibilização a platinas. Revelámos que a inclusão de montelucaste e ácido acetilsalicílico no plano de pré-medicação condicionou uma diminuição significativa da frequência e gravidade das RHS durante a dessensibilização a platinas. Na nossa série, a dessensibilização rápida não diminuiu a eficácia terapêutica dos antineoplásicos, não comprometendo assim a sobrevivência de doentes com doença oncológica metastática.Platinum-based chemotherapy regimens remain the cornerstone in the management of ovarian and colon cancer. However, their sustained/recurrent use has led to increasing reports of hypersensitivity reactions (HSR) which may preclude their subsequent use, jeopardizing the overall survival of oncologic patients. Skin testing has been considered the gold standard to identify IgE sensitization to platins, despite the occurrence of local irritative reactions and potential hazard contamination of healthcare workers. We have investigated in vitro/ ex vivo diagnostic tools aimed to complement/substitute skin testing in the evaluation of patients with HSR to platins. We have shown that the quantification of platin-specific IgE (sIgE) in the serum can be used for both diagnosis and assessment of cross-reactivity between different platins. We observed that most oxaliplatin-sensitized patients had quantifiable sIgE, not only for oxaliplatin but also for carboplatin and cisplatin; these patients thus seem to be at higher risk of developing a reaction to other platins. We further found the basophil activation test to be highly sensitive in the diagnosis of HSR to oxaliplatin, when using basophil activation marker CD203c, in comparison with CD63. In addition, we have demonstrated that when no equally effective drugs are available, rapid drug desensitization (RDD) is an effective and safe alternative to maintain the platinum drug to which the patient has reacted, even when performed in an outpatient setting. We have also identified for the first time that, in our cohort, high levels of total serum IgE were independently associated with increased risk for breakthrough HSR during RDD to platins. xv Further, we have demonstrated that acetylsalicylic acid and montelukast were effective in decreasing the number and severity of breakthrough HSR during RDD to platins, when added as premedication. Importantly, we have shown that RDD allows maintained use of critical antineoplastic drugs, without signs of impaired drug efficacy, and thus with no decline of overall survival of oncologic patients

The impact of digital influencers on product/service purchase decision making—An exploratory case study of Portuguese people

The growing use of technology and social media has resulted in the emergence of digital influencers, a new profession capable of changing the mentalities and behaviours of those who follow them. This study arises to better understand the potential impact digital influencers might have on the Portuguese population's purchase behaviour and patterns, and for this purpose, seven hypotheses were formulated. An online questionnaire was conducted to respond to these theoretical assumptions and collected data from 175 respondents. A total of 129 valid answers were considered. It was possible to conclude that purchase intention does not necessarily translate into a purchase action. It was also concluded that the relationship between social network use and the purchase of products/services recommended by influencers is only statistically significant for Instagram. Furthermore, the individuals' generation is not statistically significant / linked with purchasing a product/service recommended by influencers. Yet further, a small percentage of respondents have also identified themselves as impulsive shoppers and perceived Instagram as their favourite social network. With the results of this study, it is also possible to state that the influencer's opinion was classified as the last factor considered in the purchase decision process. Additionally, there is a weak negative association between purchasing a product/ service recommended by influencers with sponsorship disclosure and remunerated partnership, which decreases credibility and discourages purchasing, in Portugal, a feminine culture which dislikes materialism.info:eu-repo/semantics/publishedVersio

Drug desensitizations for chemotherapy: safety and efficacy in preventing anaphylaxis

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021Hypersensitivity reactions (HSRs) to antineoplastic drugs are increasing due to the expanding use of classical and new drugs in a wide variety of malignancies. PURPOSE OF REVIEW: The goal of this review is to provide current best practices in the diagnosis and management of HSRs based on data and evidence. RECENT FINDINGS: A plethora of studies have provided evidence of the safety and efficacy of rapid drug desensitizations (RDD) to allow for the reintroduction of antineoplastic drugs following an HSR, based on risk stratification. Recently described biomarkers such as basophil activation test, total IgE, BRCA genotyping, and serum IL-6 can aid in guiding improved precision desensitization protocols. Personalized premedication regimens and protocols have improved RDD safety and outcomes. RDD allows for the continued use of chemotherapeutic drugs without impaired drug efficacy. RDD represents the best approach to maintain cancer patients on their most effective treatments.info:eu-repo/semantics/publishedVersio