Acute allergic reactions to a number of cytotoxic agents used in the treatment of germ cell tumors have been documented; these agents include bleomycin,60 paclitaxel,72-74 and (rarely) carboplatin or cisplatin.57,76 These can manifest as minor reactions such as flushing and rashes or as more severe symptoms such as urticaria, periorbital edema, bronchospasm, and hypotension. In the majority of cases, the hypersensi-tivity syndromes can be treated with corticosteroids and antihistamines, and the patient can be rechal-lenged after pretreatment with these medications.7476 Hypersensitivity reactions are so common during treatment with paclitaxel (up to 30% of patients) that patients are routinely treated prophylactically with corticosteroids, cimetidine, and antihistamines.46
One of the most common acute side effects of germ cell tumor treatment is alopecia. The principal agents that cause alopecia are etoposide, ifosfamide, and paclitaxel; only WHO grade I hair loss is associated with cisplatin, vinblastine, and bleomycin, as single agents. With combination chemotherapy, used predominantly for treating this disease, the majority of patients will suffer significant alopecia.1315,50
By contrast, acute endocrine side effects occur in only a handful of patients. The syndrome of inappropriate antidiuretic hormone secretion can occur as a consequence of vinca alkaloid and/or cisplatin administration.77,78 The electrolyte imbalances spontaneously revert to normal on cessation of the relevant cytotoxic agent.
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