Fig. 2.

Approach to reintroduction of taxanes after HSRs. Patients with a history of severe cutaneous adverse drug reactions (SCARs) including Stevens-Johnson syndrome and blistering skin reactions should avoid taxanes. Grading of immediate HSR severity is based on Brown’s classification. Patients with delayed or grade 1 immediate HSRs with negative skin testing (ST −) can undergo challenge. The decision to perform desensitization or challenge in patients with grade 2 immediate HSRs who are ST − is based on patient comorbidities and comfort with the procedure. Patients with grade 3 HSRs, regardless of ST result, undergo desensitization. Institutions that do not have access to ST can follow the protocol for ST + patients. Patients who do not have breakthrough HSRs during the initial protocol can subsequently be treated with a shorter desensitization protocol, challenge, or regular infusion according to the algorithm. For patients who experience breakthrough HSRs, adjustments can be made to premedications and length of protocol. Reproduced from Fig. 1 in Picard et al. [32] with permission