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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.

RATIONALE: Chronic rhinosinusitis (CRS) is a heterogeneous chronic inflammatory disease generally divided based on presence or absence of nasal polyps (NPs). One of the clinical features is the comorbidity of asthma. Recently, the relationship between metabolic disorder and asthma have been well documented, however, it had not been well understood about CRS and metabolic disorder. We hypothesized that CRS may be related to metabolic disorders. METHODS: We measured the serum levels of leptin and adiponectin frompatients with CRS with nasal polyp (CRSwNP), patients with allergic rhinitis (AR), and healthy control subjects. According to Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis Study (JESREC Study), we divided CRSwNP patients into four group; non-eosinophilic CRS (non-ECRS), mild ECRS, moderate ECRS, and severe ECRS group. RESULTS: Although the levels of adiponectin showed no significant differences, the serum levels of leptin in ECRS group were significantly elevated compared to non-ECRS, AR, and control subjects. The levels of leptin had significant correlations between JESREC score, and the number of eosinophils in both NPs and in peripheral blood. CONCLUSIONS: Our results indicated that serum leptin levels is related to the severity of ECRS, which results may also reflect that ECRS may be related to metabolic disorders.

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