Effectiveness of carboplatin-prescreening intradermal skin tests to reduce unanticipated immediate hypersensitivity reactions: A comparative study

Background Carboplatin administration poses a risk of immediate hypersensitivity reactions (IHRs) that tend to increase with repeated administration and are mostly IgE-mediated. Objective This study evaluated the usefulness of carboplatin-prescreening intradermal skin tests (IDTs). Methods Carboplatin-prescreening IDTs were routinely conducted in patients with a history of receiving six or more carboplatin cycles from January 2021. The primary objective was to assess disparities in the incidence of unanticipated IHRs to carboplatin administration. Comparisons were made between patients in the intervention group (period: 2021–2022) and those who did not undergo prescreening IDTs under the same conditions (pre-intervention group; period: 2019–2020). The secondary objectives included evaluating the sensitivity and specificity of the prescreening IDT and the incidence of carboplatin IHR according to the number of infusion cycles. Results The intervention group comprised 67 patients who were administered 347 carboplatin cycles, whereas the pre-intervention group included 96 patients who were administered 464 carboplatin cycles. The risk of unanticipated carboplatin IHRs decreased by 83.2% in the intervention group compared to the pre-intervention group (pre-intervention group: 3.45%, N=16 vs. intervention group: 0.58%, N=2; p=0.005). The prescreening IDT showed a sensitivity and specificity of 77.78% and 99.41%, respectively. The risk of newly developed IHRs based on the number of carboplatin cycles was <1% (cycle 1-5), 2.11% (cycle 6), 3.90% (cycle 7-12), 2.90% (cycle 13-18), and 0.74% (cycle ≥ 19), respectively. Conclusions Initiating carboplatin-prescreening IDTs from the seventh cycle significantly reduced the risk of unanticipated IHRs.