Original Title: Hypersensibilité immédiate aux traitements parentéraux contre le cancer

Authors' objectives: Given the expanding range of antineoplastic drugs and the diversity of practices in Québec, the Sous-ministériat de la santé physique et pharmaceutique of the Ministère de la Santé et des Services sociaux (MSSS) has mandated the Institut national d’excellence en santé et en services sociaux (INESSS) to develop provincial recommendations and a clinical tool. The objective is to support the harmonization of prevention, acute care and treatment resumption procedures, including desensitization criteria, for all systemic cancer treatments administered parenterally.

Authors' results and conclusions: RESULTS (#1 ANTICIPATING AND DISTINGUISHING THE TYPE OF REACTION FOR A MORE EFFECTIVE RESPONSE): The ability to distinguish quickly between type 1 reactions, complement activation reactions and cytokine release reactions is crucial for safe management. While nonallergic reactions related to complement activation or cytokine release generally occur during the first infusion, type 1 allergic reactions occur after at least one well-tolerated cycle, usually after a few treatments, as observed with platinum salts. (#2 HARMONIZING PREMEDICATION, PARTICULARLY FOR PACLITAXEL): This work highlights the need to harmonize premedication used during treatments involving a risk of immediate hypersensitivity reactions. More specifically, they indicate that second-generation histamine H1 receptor antagonists (anti-H1) (e.g., cetirizine, loratadine) may be considered as a replacement for diphenhydramine when an anti-H1 is required as part of a premedication protocol. (#3 AVOIDING STANDARD RE-EXPOSURE TO PLATINUM SALTS AFTER ANY TYPE 1 REACTION): Following a type 1 reaction, standard re-exposure to platinum salts is strongly discouraged, even if the initial reaction was mild or if a reduced-flow infusion was tolerated on the day of the initial reaction. CONCLUSION: This work can serve as a starting point for developing and updating preformatted individual prescriptions and collective prescriptions by healthcare teams.

Authors' recommendations: The work recommends wider and earlier use of intramuscular epinephrine. It should be administered as a first-line treatment for any severe reaction or for a moderate reaction that does not improve within five minutes of interrupting the infusion.

Authors' methods: For this work, the evaluation questions were designed to address the clinical dimension as well as population-based, organizational, economic and sociocultural dimensions, along with ethical and environmental issues as presented in the INESSS Statement of Principles and Ethical Foundations. A systematic review of documents presenting clinical recommendations and information was carried out based on publications listed in bibliographic databases and other sources, supplemented by an analysis of contextual factors specific to Québec, including regulatory and organizational frameworks. Stakeholder perspectives were gathered by an advisory committee made up of health professionals from various specialties and areas of expertise.

Project Status: Completed

Year Published: 2026

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/hypersensibilite-immediate-aux-traitements-parenteraux-contre-le-cancer-chez-ladulte.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)