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RATIONALE: Carboplatin is chemotherapy of choice for treatment of gynecologic malignancy. Patients received multiple course therapy have increase rate of hypersensitivity reaction (HSR) up to 27%. Switch to alternative regimens may shorten progression free survival (PFS) and overall survival (OS). Rapid desensitization has been used to provide safe reintroduction of carboplatin treatment. METHODS: Retrospective review of consecutive patients experienced carboplatin HSR who visit Allergy clinic, Ramathibodhi hospital from June 2010 to June 2020 were collected. Onco-Gynecology -Allergy multidisciplinary team workflow was established in 2016 to offer rapid access to skin test (ST). Patients who had initial negative carboplatin ST were follow and repeated ST until conversion to positive or completion of carboplatin treatment. Patient's demographic data, including disease status and severity of initial HSR to carboplatin were collected. RESULTS: Seventy-one patients were included. Mean age was 57.8 years (SD 9.93). Majority of patients (80.3%) were recurrent disease, mostly on second course of carboplatin. Mean carboplatin cycle before developing initial HSR was 15.35 (range 6-42, SD 6.211). One-third of patients (38.0%) had only mild cutaneous reaction, while 18.3% had anaphylactic shock. Skin test positive was found in 55 patients (77.5%). Of 16 patients with Initial negative ST results, 6 patients changed chemotherapy regimens, while all of 10 patients who continue the same regimen converted to positive result at a median of 2.1 cycles (range 1-4). CONCLUSIONS: Multidisciplinary team approach provided rapid accessibility to ST to carboplatin. Interestingly all patients were finally converted to positive result at a median of 2.1 cycles.

The Pediatric Quality of Life (QOL) Inventory TM (PedsQL) survey measures health-related QOL in children with chronic health conditions. The primary purpose of this study is to examine QOL in pediatric patients with eosinophilic esophagitis (EoE) at their initial clinic visit based on their pre-visit treatment. METHODS: The PedsQL survey was given to 107 children aged 4-18 years referred for food allergies or EoE seen for initial consultation in the Texas Children's Hospital Allergy/Immunology Clinic from October 2014-September 2017. Measured outcomes included physical, social, emotional, and school functioning domain scores. Higher scores correlate with better QOL. Independent t-tests, Fisher's exact tests, Chi-square tests and multiple logistic regression were used for analysis. RESULTS: Twenty-four child surveys were completed at initial visit with an EoE diagnosis. Prior to initial visit, 19 were treated with elimination diet, 9 with steroids, and 15 with proton pump inhibitors (PPI). Children treated with PPIs had an initial school functioning score 16 points lower (95% CI:-28.77,-3.23) than those who were not treated with PPIs. No statistically significant differences were found in the other domains between those treated with diet, steroids, and/or PPIs versus untreated children. CONCLUSIONS: In this study, QOL survey scores were significantly lower in patients with EoE who were treated with PPI prior to initial allergy clinic visits. This finding may be related to symptom severity, the burden of taking medications, or lack of improvement on medication. Further investigation is warranted to address what drives the initial low QOL score in PPI-treated patients.

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