Regional Center of Allergy and Clinical Immunology, University Hospital "Dr Jose Eleuterio Gonzalez", Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico.
J Oncol Pharm Pract. 2021 Mar;27(2):490-493. doi: 10.1177/1078155220939143. Epub 2020 Jul 7.
Platinum compounds are frequently used for the treatment of colorectal cancer as initial chemotherapy. Oxaliplatin is a third-generation platinum used for the treatment of stage III colorectal cancer and is associated with hypersensitivity reactions. The incidence of hypersensitivity reaction is approximately 12%, with 1-2% of patients developing moderate to severe reactions.
A 54-year-old male patient with stage III B colon cancer was diagnosed and chemotherapy with oxaliplatin was indicated by the oncology service. Within 20 min of the first cycle of oxaliplatin, he developed dyspnea, laryngeal spam, foreign body sensation in the throat, nausea, and diarrhea; therefore, the infusion of oxaliplatin was suspended, and intramuscular epinephrine was administered and intravenous hydrocortisone along with chlorpheniramine with adequate resolution of symptoms. Intradermal skin test performed at the concentration of 5 mg/ml (dilution 1:100) was positive. Due to the symptoms presented we decided to perform desensitization to oxaliplatin (total dose: 250 mg) with three bags-12 steps protocol with an initial concentration dose of 1/100 of the total dose in a course of 5.56 h with no hypersensitivity reactions.
Approximately 50% of patients who are exposed to oxaliplatin may have hypersensitivity despite premedication. Desensitization protocol induces tolerance to a drug temporarily and is dependent on continuous exposure.
铂类化合物常被用作结直肠癌的初始化疗药物。奥沙利铂是第三代铂类药物，用于治疗 III 期结直肠癌，与过敏反应有关。过敏反应的发生率约为 12%，其中 1-2%的患者出现中度至重度反应。
一名 54 岁男性患者被诊断为 IIIB 期结肠癌，肿瘤专科建议进行奥沙利铂化疗。在第一周期奥沙利铂输注的 20 分钟内，他出现呼吸困难、喉痉挛、喉咙异物感、恶心和腹泻；因此，停止输注奥沙利铂，给予肌内肾上腺素，并静脉注射氢化可的松和氯苯那敏，症状得到充分缓解。在 5mg/ml（稀释度 1:100）的浓度下进行的皮内皮肤试验呈阳性。由于出现的症状，我们决定对奥沙利铂进行脱敏（总剂量：250mg），采用三个袋子-12 步方案，在 5.56 小时内用总剂量的 1/100 初始浓度进行，无过敏反应。
尽管进行了预处理，但约 50%接触奥沙利铂的患者可能会出现过敏反应。脱敏方案暂时诱导对药物的耐受性，并且取决于持续暴露。
