A New Practical Desensitization Protocol for Oxaliplatin-Induced Immediate Hypersensitivity Reactions: A Necessary and Useful Approach

Abstract

Background and Objective: Desensitization protocols for patients with immediate hypersensitivity reactions (IHSRs) have proven to be effective, but they are not widely used in clinical practice because of impracticalities such as high cost, long procedure duration, and a lack of trained personnel. We aimed to determine the clinical characteristics of oxaliplatin-induced IHSRs and assess measures to protect against these reactions and to validate a new practical desensitization protocol. Methods: We retrospectively reviewed 2640 cases of oxaliplatin IHSRs in 271 oxaliplatin users and prospectively used a newly designed desensitization protocol 32 times in 12 patients with hypersensitivity to platinum-based chemotherapy. The protocol consisted of increases in infusion rate every 15 minutes, regardless of the concentration of the chemotherapy agent in the infusion bags. Results: Of the 271 patients administered oxaliplatin, 45 (16.6%) experienced IHSRs. Of 39 patients who experienced an IHSR but needed to continue oxaliplatin, 6 (15.4%) stopped treatment due to the reaction, and 33 (84.6%) continued despite the risk of further reactions. The new desensitization protocol was successfully completed in 12 patients (100%), but it was ineffective in 3 patients (all with a negative skin prick test), who experienced fever without urticaria. Conclusions: Many patients who experience oxaliplatin-induced IHSRs are required to stop first-line oxaliplatin-based chemotherapy or to continue without desensitization, with the associated risks. Our new desensitization protocol is practical and easy to use in clinical practice.

Successful oxaliplatin desensitization protocol in a patient with colorectal metastatic cancer

“…It has been reported that between 12 and 24% of patients experienced immediate HSR to this drug, and the prevalence of reactions is rising at a rate parallel to that of oxaliplatin use. 7…”

A Case of Intraoperative Anaphylaxis Caused by Bovine-Derived Thrombin

“…Burn out of allergic reactions related to the mediators might have caused a full recovery (called desensitization) in short period of time. 16 The dissolution of bovine thrombin products in her neck tissues according to half-life may have led to long-term recovery.…”

Comparison between hypersensitivity reactions to cycles of modified FOLFOX6 and XELOX therapies in patients with colorectal cancer

“…These rates were slightly lower than those observed in the present XELOX-treated cohort. However, the reported L-OHP HSR rates have tended to range widely from 8.9 to 23.8% in previous studies [5–17], which included patients with different treatment backgrounds. Therefore, we assume that the present HSR rates are within the expected range.…”

“…Although the type of HSR, incidence rate and time to occurrence tend to vary among platinum compounds [4], the ensuing details remain largely unknown. Reported rates of HSRs to L-OHP, in the absence of any countermeasures, range from 8.9 to 23.8% [5–17]. In a comparative study of three platinum-based compounds published in 2010, HSRs to L-OHP typically occurred after six treatment cycles [4].…”