Allergy Asthma Immunol Res.  2016 Mar;8(2):174-177. 10.4168/aair.2016.8.2.174.

The Hidden Culprit: A Case of Repeated Anaphylaxis to Cremophor

• Kim YN
• Kim JY
• Kim JW
• Kim JH
• Kim HI
• Yune S
• Choi DC
• Lee BJ

• KMID: 2165935
• DOI: http://doi.org/10.4168/aair.2016.8.2.174

Abstract

Drug-induced anaphylaxis is a big pitfall in patients receiving antineoplastic chemotherapy. We report a case of lung cancer patient who experienced two near-fatal anaphylactic reactions that resulted from paclitaxel and multivitamin, seperately. Recurrent severe reactions to different agents led to further investigation to which material the patient was hypersensitive. The skin prick test revealed sensitization to cremophor, which is a commonly used emulsifying agent. This case emphasizes the importance of correctly identifying the culprit drug of anaphylaxis to avoid potentially fatal reaction.

Keyword

Anaphylaxis; paclitaxel; multivitamin; cremophor; hypersensitivity

MeSH Terms

Anaphylaxis*
Drug Therapy
Humans
Hypersensitivity
Lung Neoplasms
Paclitaxel
Skin
Paclitaxel

Figure

• 

  Figure Skin prick test results of ingredients of multivitamin and polysorbate (A: patient, B: healthy control). 1, cremophor; 2, polysorbate; 3, vitamin B3; 4, vitamin C; 5, vitamin E; 6, vitamin A; 7, vitamin B5; 8, vitamin B1; 9, vitamin B6; 10, sodium hydroxide; 11, vitamin B2; 12, propyleneglycol.

Reference

1. Gelderblom H, Verweij J, Nooter K, Sparreboom A. Cremophor EL: the drawbacks and advantages of vehicle selection for drug formulation. Eur J Cancer. 2001; 37:1590–1598.

2. Wiernik PH, Schwartz EL, Strauman JJ, Dutcher JP, Lipton RB, Paietta E. Phase I clinical and pharmacokinetic study of taxol. Cancer Res. 1987; 47:2486–2493.

3. Picard M, Castells MC. Re-visiting hypersensitivity reactions to Taxanes: a comprehensive review. Clin Rev Allergy Immunol. Forthcoming 2014.

4. Riegert-Johnson DL, Volcheck GW. The incidence of anaphylaxis following intravenous phytonadione (vitamin K1): a 5-year retrospective review. Ann Allergy Asthma Immunol. 2002; 89:400–406.

5. Dye D, Watkins J. Suspected anaphylactic reaction to Cremophor EL. Br Med J. 1980; 280:1353.

6. Baker MT, Naguib M. Propofol: the challenges of formulation. Anesthesiology. 2005; 103:860–876.

7. Volcheck GW, Van Dellen RG. Anaphylaxis to intravenous cyclosporine and tolerance to oral cyclosporine: case report and review. Ann Allergy Asthma Immunol. 1998; 80:159–163.

8. Gradishar WJ, Tjulandin S, Davidson N, Shaw H, Desai N, Bhar P, et al. Phase III trial of nanoparticle albumin-bound paclitaxel compared with polyethylated castor oil-based paclitaxel in women with breast cancer. J Clin Oncol. 2005; 23:7794–7803.

9. Takashima S, Kiyoto S, Takahashi M, Hara F, Aogi K, Ohsumi S, et al. Clinical experience with nanoparticle albumin-bound paclitaxel, a novel taxane anticancer agent, and management of adverse events in females with breast cancer. Oncol Lett. 2015; 9:1822–1826.

10. ABRAXANE® (US). Abraxane Prescribing Information [Internet]. Summit (NJ): ABRAXANE®;2014. cited 2014 Jan 3. Available from: http://www.abraxane.com/downloads/Abraxane_PrescribingInformation.pdf.

11. Essayan DM, Kagey-Sobotka A, Colarusso PJ, Lichtenstein LM, Ozols RF, King ED. Successful parenteral desensitization to paclitaxel. J Allergy Clin Immunol. 1996; 97:42–46.

12. Irizarry LD, Luu TH, McKoy JM, Samaras AT, Fisher MJ, Carias EE, et al. Cremophor EL-containing paclitaxel-induced anaphylaxis: a call to action. Community Oncol. 2009; 6:132–134.

13. Ebo DG, Piel GC, Conraads V, Stevens WJ. IgE-mediated anaphylaxis after first intravenous infusion of cyclosporine. Ann Allergy Asthma Immunol. 2001; 87:243–245.

14. Dizon DS, Schwartz J, Rojan A, Miller J, Pires L, Disilvestro P, et al. Cross-sensitivity between paclitaxel and docetaxel in a women's cancers program. Gynecol Oncol. 2006; 100:149–151.

15. Szebeni J, Muggia FM, Alving CR. Complement activation by Cremophor EL as a possible contributor to hypersensitivity to paclitaxel: an in vitro study. J Natl Cancer Inst. 1998; 90:300–306.

16. Bennett CL, Adegboro OS, Calhoun EA, Raisch D. Beyond the black box: drug- and device-associated hypersensitivity events. Drug Healthc Patient Saf. 2010; 2:1–5.

17. Moon C, Verschraegen CF, Bevers M, Freedman R, Kudelka AP, Kavanagh JJ. Use of docetaxel (Taxotere) in patients with paclitaxel (Taxol) hypersensitivity. Anticancer Drugs. 2000; 11:565–568.

18. Kessell J, Assem ES. Letter: an adverse reaction to althesin. Br J Anaesth. 1974; 46:209.