Standardization of Skin Tests for Diagnosis and Prevention of Hypersensitivity Reactions to Oxaliplatin

Abstract

Background: Platinum salts can cause allergic sensitization. Recently, hypersensitivity reactions to oxaliplatin, the most recent platinum coordination complex introduced into clinical practice, have been reported. Objective: To validate and standardize skin tests to diagnose and possibly prevent hypersensitivity reactions to oxaliplatin. The secondary aims were to confirm IgE-mediated pathogenesis of the clinical manifestations and to evaluate skin tests to predict patients at risk of hypersensitivity reactions to oxaliplatin. Methods: We performed skin tests atincreasing concentrations of oxaliplatin on 15 patients never exposed to platinum salts, on 10 patients treated with oxaliplatin without any adverse reactions, and on 4 patients who had shown hypersensitivity reactions to the drug. Moreover we performed skin tests on 8 additional patients starting before the 5th dose and following a course of chemotherapy. Results: A positive skin reaction to the prick test at a concentration of 1 mg/ml was seen in 1 patient with hypersensitivity reactions. The intradermal test was positive in all the patients with hypersensitivity reactions at a concentration of 0.1 mg/ml. It was negative in the 15 nonexposed subjects, and in the 10 patients who had been exposed to oxaliplatin without hypersensitivity reactions. The skin test administered to patients before chemotherapy was positive in one case. Conclusion: A skin prick test at a concentration of 1 mg/ml and, in the case of a negative response, an intradermal test at the optimal concentration of 0.1 mg/ml should be used, starting from the 5th course of therapy, to diagnose and prevent hypersensitivity reactions to oxaliplatin.

Oxaliplatin-induced lung injury with allergic reaction

“…Early signs may be seen in some of the patients, e.g., erythema or other unusual toxic events caused by oxaliplatin. There is evidence about the usefulness of skin tests for the prevention of allergic events due to oxaliplatin [12] . DLST may also be a helpful tool to make an earlier diagnosis.…”

Oxaliplatin-Free Interval as a Risk Factor for Hypersensitivity Reaction among Colorectal Cancer Patients Treated with FOLFOX

“…Although skin tests have been reported to predict oxaliplatin allergy [30], the reality of performing tests for every oxaliplatin administration is time-consuming and involves discomfort for the patient. However, it may be feasible to limit use to at least the second or third cycles of the reintroduction phase, when the incidence of HSR is highest.…”

“…Identifying high-risk patients is of great clinical importance, since oxaliplatin HSR may be fatal if the condition is severe. Skin tests have been reported to predict oxaliplatin allergy [8,18,19,20], but no specific prospective protocol for HSR skin testing has yet been established. After the introduction of the stop-and-go strategy at the Kyoto University Hospital, we experienced several cases of severe HSR during the second or third cycle after oxaliplatin reintroduction, which prompted us to further investigation.…”

High-dose dexamethasone plus antihistamine prevents colorectal cancer patients treated with modified FOLFOX6 from hypersensitivity reactions induced by oxaliplatin

“…Allergic reactions usually develop after several infusions of oxaliplatin [13]. In cohort 2 of our study, the use of modified premedication decreased the incidence of hypersensitivity reactions to 7.0%.…”