title: Hypersensitivity reactions to oxaliplatin: a retrospective study and the development of a desensitization protocol.
abstract: BACKGROUND
  We recorded the epidemiologic and clinical features of hypersensitivity reactions (HSRs) to oxaliplatin in colorectal cancer (CRC) patients in order to provide information on the management of these patients. We also developed a desensitization protocol and evaluated its clinical application. For these reasons, we analyzed retrospectively the records of 215 CRC patients treated with oxaliplatin-containing regimens either as an adjuvant, first-line, second-line, or more.
  
  
  METHODS
  Data from 52 patients with HSRs were analyzed according to the Common Toxicity Criteria for Adverse Events (CTCAE), v3.0. Three patients were chosen for the desensitization protocol. After determining the starting point for desensitization, we applied the standard protocol for parenteral desensitization to b-lactam antibiotics. Oxaliplatin treatment was then carried out with serial 10-fold dilutions in sufficient volume to administer the total dose. A total of 52 patients (24.2%) were recorded as having an allergic reaction to oxaliplatin.
  
  
  RESULTS
  Hypersensitivity reactions were recorded after a mean of 6.5 (SD +/- 4.5) cycles. Only 4 patients (4 of 215; 1.8%) developed CTCAE grade 3/4 HSRs. Hypersensitivity reactions were seen more likely in patients receiving second-line or more of chemotherapy compared with chemotherapy-naive patients. No other correlations were seen (the presence of atopic disease, positive skin prick test). The 3 patients, having completed the parenteral desensitization protocol, completed their treatment uneventfully as well.
  
  
  CONCLUSIONS
  Hypersensitivity reactions from oxaliplatin respond quickly to the discontinuation of the drug and appropriate support. Premedication and an increased infusion time could allow for readministration. The desensitization protocol we developed can provide a reliable alternative to permanent discontinuation of oxaliplatin.
authors.affiliation: Oncology Unit, Third Department of Medicine, Sotiria General Hospital, Athens Medical School, Athens, Greece.
authors.forename: Ekaterini I
authors.initials: EI
authors.lastname: Syrigou
authors.forename: Eleni M
authors.initials: EM
authors.lastname: Karapanagiotou
authors.forename: Christina V
authors.initials: CV
authors.lastname: Alamara
authors.forename: Paraskevi G
authors.initials: PG
authors.lastname: Boura
authors.forename: Muhammad W
authors.initials: MW
authors.lastname: Saif
authors.forename: Kostas N
authors.initials: KN
authors.lastname: Syrigos
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D003888:Desensitization, Immunologic / Q000379:methods*; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000009:adverse effects*; D000077150:Oxaliplatin; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin