The following is a summary of “Cytokine profiling, pretreatment with anakinra, and tolerance development in platinum-induced mixed hypersensitivity reactions,” published in the October 2023 issue of Allergy, Asthma & Immunology by Picard, et al.
Cytokine-release responses (CRR) caused by platinum-based chemotherapy, which shows up as fever, chills, and stiffness, are not well known and are not easily stopped by standard premedication or desensitization. Researchers want to learn more about platinum-induced CRR and how anakinra can be used to stop its clinical symptoms. Researchers collected a group of cytokines and chemokines before and after platinum injection in three people who had a mixed (immunoglobulin E-mediated and CRR) platinum-induced hypersensitivity reaction and in 5 controls who were either immune to platinum or had an immunoglobulin E-mediated platinum-induced hypersensitivity reaction.
In the three CRR cases, anakinra was given before the medicine. In all cases, the cytokine-release response was linked to a significant release of interleukin (IL)-2, IL-5, IL-6, IL-10, and tumor necrosis factor-ɑ. In some controls, only IL-2 and IL-10 rose after platinum infusion, and not as much as in other cases. Two people who took Anakinra didn’t have any CRR signs. The third person initially had CRR symptoms even though they were taking anakinra. Tolerance to oxaliplatin seemed to develop after repeated exposures, as shown by the fact that cytokines levels dropped after oxaliplatin, except for IL-10, and the patient was able to gradually shorten the desensitization protocol and taper off of the premedication. Additionally, the oxaliplatin skin test result became negative.
Anakinra might be a good premedication for people with platinum-induced CRR because it blocks its clinical effects. Also, keeping an eye on IL-2, IL-5, IL-6, IL-10, and tumor necrosis factor-ɑ could help predict tolerance development, which would allow safe changes to be made to the desensitization protocol and premedication.