Successful 15-step desensitization protocol for nivolumab and ipilimumab after a skin-test confirmed anaphylaxis to polysorbate 80: case report.
Clement Svabek, Sophie Maiezza, Arthur Lecoutre et al.
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Case in brief
A 53-year-old man with advanced melanoma developed grade III anaphylaxis during his first nivolumab infusion. Allergy testing showed immediate hypersensitivity to polysorbate 80 and a positive test to polysorbate 20, limiting alternative checkpoint inhibitor options. After melanoma progression prompted combined immunotherapy, clinicians used a one-bag, 15-step desensitization protocol for sequential nivolumab and ipilimumab. Both desensitizations were completed without anaphylaxis, enabling subsequent administration of standard doses.
What made this case unusual
The case involved skin-test-confirmed polysorbate 80 hypersensitivity, with polysorbate 20 testing also positive, yet desensitization enabled use of both nivolumab and ipilimumab.
Diagnostic / clinical pearl
After anaphylaxis during checkpoint inhibitor infusion, allergy testing can identify sensitivity to a shared excipient; in this case, a 15-step protocol enabled subsequent nivolumab and ipilimumab administration without anaphylaxis.
Why it matters
The report describes a potential option when excipient-free checkpoint inhibitors are unavailable and combined immunotherapy is needed.