title: Oxaliplatin hypersensitivity: evaluation, implications of skin testing, and desensitization.
abstract: BACKGROUND
  Oxaliplatin hypersensitivity (OXS) presents a challenge in the treatment of oxaliplatin-sensitive malignancies.
  
  
  OBJECTIVE
  To analyze patient characteristics of patients with OXS, skin test results, and desensitization outcomes to optimize management.
  
  
  METHODS
  Over 5 years, 48 patients with OXS were referred to the allergy/immunology unit at Massachusetts General Hospital. Their clinical reaction patterns were analyzed. Immediate hypersensitivity skin testing was used for risk stratification, and drug desensitizations were performed by using 3 related continuous intravenous protocols that were chosen based on clinical history, skin test reactivity, and the patients' previous desensitization outcomes.
  
  
  RESULTS
  OXS occurred in both sexes, with mostly gastrointestinal-related tumors. Hypersensitivity reaction (HSR) onset had occurred during any course of therapy (course nos. 1-28), with a median onset at course no. 8. HSR to oxaliplatin was similar to those observed with cisplatin and carboplatin, including cutaneous, cardiovascular, pulmonary, and gastrointestinal symptoms. However, neurologic symptoms, including tingling, and systemic symptoms, including fever and chills, occurred more often in patients with OXS. Unique to OXS, 2 patients developed drug-induced thrombocytopenia; 1 patients also developed drug-induced hemolytic anemia. Skin testing was positive for the majority of patients with OXS (27/46 [59%]) and correlated with a greater likelihood of developing an HSR during subsequent desensitizations. We safely performed 200 desensitizations in 48 patients with OXS.
  
  
  CONCLUSIONS
  OXS is common with much similarity to other platin agents but also have distinct differences in the onset of hypersensitivity, sex, tumor type, drug-induced hemolytic anemia, and drug-induced thrombocytopenia. Skin testing was helpful for risk stratification. All of the desensitizations were completed successfully.
authors.affiliation: Department of Medicine, Allergy and Immunology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Mass. Electronic address: jwong1@partners.org.
authors.forename: Johnson T
authors.initials: JT
authors.lastname: Wong
authors.affiliation: Department of Medicine, Allergy and Immunology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Morris
authors.initials: M
authors.lastname: Ling
authors.affiliation: Department of Medicine, Allergy and Immunology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Sarita
authors.initials: S
authors.lastname: Patil
authors.affiliation: Department of Medicine, Allergy and Immunology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Aleena
authors.initials: A
authors.lastname: Banerji
authors.affiliation: Department of Medicine, Allergy and Immunology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Aidan
authors.initials: A
authors.lastname: Long
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000276:immunology; D001900:Boston; D003888:Desensitization, Immunologic / Q000379:methods; D004334:Drug Administration Schedule; D004342:Drug Hypersensitivity / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage* / Q000009:adverse effects* / Q000276:immunology; D000077150:Oxaliplatin; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012882:Skin Tests; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin
keywords: CAS; CIS; Carboplatin; Carboplatin hypersensitivity; Cisplatin; Cisplatin hypersensitivity; Continuous; DIHA; DITP; Desensitization; Drug-induced hemolytic anemia; Drug-induced thrombocytopenia; GI; Gastrointestinal; HRP; HSR; High-risk protocol; Hypersensitivity; Hypersensitivity reaction; IP; Ig; Immunoglobulin; Intermediate protocol; Intravenous; OXS; Onset; Oxaliplatin; Oxaliplatin hypersensitivity; RP; Rapid protocol; Skin test