Metal-Based Drugs Duration Success rate Steps From 1 : 1000 to 1 : 10 on 1st day (in 3 steps), from 1 : 10 to 1 : 1 on 2nd day (in 2 steps) From 1 : 1000 to 1 : 1 in 4 steps From 1 : 100 to 1 : 1 (in 8−10 steps) From 1 : 100 to 1 : 1 in 12 steps From 1 : 1000 to 1 : 1 in 4 steps From 1 : 100 to 1 : 1 in 12 steps(higher concentrations as outpatient) 2 days (3 hours on 1st day, 9 hours on 2nd day) 2 hours 11 hours 5.8 hours 6 hours 5.8 hours (inpatient) 3.8 hours (outpatient) 4 Abe et al. (2010) [50] Gomez et al. (2009) [51] Hesterberg et al. (2009) [52] Castells et al. (2008) [53] Conﬁno- Cohen et al. (2005) [54] Lee et al. (2005) [55] Jones et al. (2003) [57] Rose et al. (2003) [33] Patients 3 (carboplatin replaced by cisplatin after desensitization) 63 (60 hypersensitive to carboplatin, 3 to cisplatin) 31 (1st desensitization in intensive care unit—subsequent as outpatient) 5 (carboplatin replaced by cisplatin after desensitization) 7 30 23 33 Markman et al. (2004) [56] 5 (desensitization and retreatment with carboplatin or cisplatin) BID: twice a day, iv: intravenously, po: by mouth, QD: once a day, QID: four times a day, TID: three times a day. Table 4: Main desensitization protocols for carboplatin-cisplatin hypersensitivity. We observe that all protocols deliver the platinum agent at escalating concentrations and administer premedication. 100% 71% 99% Severe reactions in 6% of courses (full target dose with treatment) 86.9% 85% courses without symptoms (full target dose with treatment) 80% 60% 79% Premedication dose route Dexamethasone 20 mg, promethazine 50 mg, ranitidine 50 mg Dexamethasone at least 20 mg iv 30, clemastine 2 mg iv Fexofenadine 180 mg po and/or desloratadine 5 mg po BID, Dexamethasone 10 mg po Diphenhydramine or hydroxyzine 25 mg po or iv, famotidine 20 mg iv or ranitidine 50 mg iv, lorazepam (0.5-1 mg po or iv as needed for anxiety) Dexamethasone 8−12 mg iv, ondansetron iv Diphenhydramine 25 mg iv, famotidine 20 mg iv Lorazepam 1 mg (as needed for anxiety) Zileuton 600 mg po QID (5 days), montelukast sodium 10 mg po QD (5 days), indomethacin 50 mg po TID (1 day), albuterol sulfate 8 mg po BID (1 day), famotidine 20 mg iv, dexamethasone 20 mg iv, diphenhydramine 50 mg iv Dexamethasone 20 mg po (4 days ), diphenhydramine 50 mg po (4 days), ranitidine 50 mg iv, dexamethasone 20 mg iv, ondansetron 8 mg iv Dexamethasone 20 mg po or iv 6 hours before, Dexamethasone 20 mg iv and diphenhydramine 50 mg iv 30 minutes before From 1 : 1000 to 1 : 1 in 4 steps 90 minutes From 1 : 1000 to 1 : 1 in 4 steps From 1 : 1000 to 1 : 1 in 4 steps 2 hours 16.5 hours