Suspected Paclitaxel Allergy Following Angioplasty With a Drug-Coated Balloon

Purpose: Paclitaxel is a chemotherapeutic agent which may be administered locally to an arterial lesion via a drug-coated balloon or drug-eluting stent. We report an allergic reaction to locally administered paclitaxel. Case Summary: A 75 year-old woman underwent a right external iliac to superior mesenteric artery bypass and presented a year later with evidence of iliac artery stenosis, which was repaired via angioplasty and stenting. Two years later, the patient presented again with restenosis. She underwent balloon angioplasty of affected vessels with an IN.PACT Admiral® 6 × 40 drug-coated (Paclitaxel) balloon. The patient presented to her local hospital a week later with severe pruritis and a rash, for which she received a dose of parenteral steroid. Despite the patient’s denial of changes in medication or environmental changes, she continued to experience hypersensitivity symptoms which required recurrent courses of oral prednisone, diphenhydramine, and cetirizine before finally resolving. Conclusion: To our knowledge, a severe allergic reaction to paclitaxel has not been reported when administered locally using either a drug-coated balloon or a drug-eluting stent. This case emphasizes that severe allergic reactions can occur. Because the drug is embedded in the arterial tissue, it cannot be easily removed, and such allergic reactions should be treated with systemic corticosteroids and antihistamines. The allergic reaction should be self-limited as the drug is eliminated over time.