Oxaliplatin-induced hypersensitivity reaction displaying marked elevation of immunoglobulin E.
A 74-year-old female has been diagnosed with stage IIIB rectal cancer in 2003. Following anterior resection, she received adjuvant chemotherapy with three different regimens. In August 2005, she was started on a modified FOLFOX6 regimen, and the sixth cycle of chemotherapy induced a severe hypersensitivity reaction (HSR). Immediate cessation of the infusion resulted in a disappearance of the allergic reaction 60 min later. Blood tests just after the reaction demonstrated a marked elevation of immunoglobulin E to 300 IU L(-1) (normal range: <170 IU L(-1)). This change implies the involvement of a type I reaction in the HSR. In addition, a drug lymphocyte stimulating test against oxaliplatin and levofolinate calcium (an isomer of leucovorin calcium) gave values of 696% and 107 % respectively, as compared with control serum. This suggests that the patient had an adverse reaction not only of type I but partly of type IV allergic reaction also. Oxaliplatin appears to have caused a HSR in this Japanese patient, and thus pharmacists, physicians, and other medical staff must keep a careful watch of a patient's clinical condition during chemotherapy including oxaliplatin.
Department of Hospital Pharmacy, Takarazuka Municipal Hospital, Takarazuka, Hyogo, Japan. nkitada@poppy.kyoto-phu.ac.jp
Noriaki
N
Kitada
Toshiyuki
T
Dan
Kohji
K
Takara
Takashi
T
Tsuji
Hajime
H
Yamasaki
Teruyoshi
T
Yokoyama
Masakatsu
M
Watari
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000276:immunology*; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000187:drug effects / Q000378:metabolism; D007564:Japan; D008213:Lymphocyte Activation; D009944:Organoplatinum Compounds / Q000009:adverse effects*; D000077150:Oxaliplatin; D012004:Rectal Neoplasms / Q000188:drug therapy
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D007073:Immunoglobulin E