Fig. 1.

Mechanisms of immediate HSRs to platins and taxanes. Phenotypes of platin HSRs include type I reactions, cytokine release reactions, and mixed reactions, with the most heterogeneity seen with oxaliplatin (A). Taxanes may cause mast cell and/or basophil activation through IgE-mediated mechanisms, direct action on basophils, or IgG-mediated mechanisms that cause complement activation and release of anaphylatoxins (C3a, C5a) (A, B). Solvents for taxanes, such as Cremophor EL (paclitaxel) and polysorbate 80 (docetaxel), may also activate mast cells through an IgE-mediated mechanism or direct complement activation. Biomarkers include tryptase, histamine, leukotrienes, and prostaglandins in type I reactions and IL-6, TNF-α, and IL-1ß in cytokine release or mixed reactions (A, B). Desensitization is indicated for type I reactions and selected cases of cytokine release and mixed reactions, but not in direct mast cell/basophil activation (A). LTC4 leukotriene C4, PGD2 prostaglandin D2. Reproduced from Fig. 1 in Castells [65] and Fig. 3 in Picard and Castells [15] with permission