Vázquez-Revuelta Paula, Madrigal-Burgaleta Ricardo, Ruffinelli J Carlos, Casanovas Enric, Coloma Ana, Lleonart Ramon
Drug Hypersensitivity and Desensitization Centre (DHDC), Institut Català d'Oncologia (ICO), Barcelona, Spain.
Allergy Department, Hospital Universitari de Bellvitge (HUB), Barcelona, Spain.
Front Pharmacol. 2025 Aug 29;16:1605690. doi: 10.3389/fphar.2025.1605690. eCollection 2025.
Oxaliplatin (OXL) is a key treatment for colorectal cancer but can potentially induce type II hypersensitivity reactions (II-HSRs), leading to immune-mediated cytopenias. The prevalence and management of OXL-induced II-HSRs remain poorly understood, with evidence being mainly anecdotal and lacking a systematic approach. This study examines the prevalence, clinical presentation, diagnosis, and management of OXL-induced II-HSRs in our population.
We prospectively analysed a cohort of OXL-reactive patients at our Drug Hypersensitivity and Desensitisation Centre between January 2019 and April 2024. Patients with clinical and laboratory findings suggestive of II-HSR were included and classified into acute immune thrombocytopenia (AIT), immune haemolytic anaemia (IHA), Evans syndrome (ES), or drug-induced thrombotic microangiopathy (DITMA). Drug-dependent antibodies (DDAbs) were detected via flow cytometry. Carefully selected patients underwent re-exposure to OXL under allergy care and special safety measures.
Sixteen patients were diagnosed with II-HSRs, with a prevalence of 9.5% among OXL-reactive patients. The mean number of OXL cycles at onset was 20. Atypical hypersensitivity symptoms such as chills, fever, and back pain aided clinical identification. AIT was the most common presentation (56%), followed by ES (38%), and one case of DITMA (6%). DDAbs were detected in 86% of cases, with two patients showing DDAbs to other drugs. Five selected patients were re-exposed to OXL without significant complications.
OXL-induced II-HSRs are rare but pose diagnostic and management challenges. This study shows the importance of early identification, the potential role of DDAbs testing, and the feasibility of re-exposure under controlled conditions in selected patients.
奥沙利铂（OXL）是结直肠癌的关键治疗药物，但可能诱发II型超敏反应（II-HSRs），导致免疫介导的血细胞减少。奥沙利铂诱发的II-HSRs的患病率和管理仍知之甚少，证据主要是轶事性的，缺乏系统的方法。本研究调查了我们人群中奥沙利铂诱发的II-HSRs的患病率、临床表现、诊断和管理。
我们对2019年1月至2024年4月期间在我们的药物过敏和脱敏中心的一组对奥沙利铂有反应的患者进行了前瞻性分析。纳入有临床和实验室检查结果提示II-HSR的患者，并将其分为急性免疫性血小板减少症（AIT）、免疫性溶血性贫血（IHA）、伊文氏综合征（ES）或药物性血栓性微血管病（DITMA）。通过流式细胞术检测药物依赖性抗体（DDAbs）。精心挑选的患者在过敏护理和特殊安全措施下再次接触奥沙利铂。
16例患者被诊断为II-HSRs，在对奥沙利铂有反应的患者中的患病率为9.5%。发病时奥沙利铂治疗周期的平均次数为20次。寒战、发热和背痛等非典型过敏症状有助于临床识别。AIT是最常见的表现（56%），其次是ES（38%），还有1例DITMA（6%）。86%的病例检测到DDAbs，2例患者对其他药物显示有DDAbs。5例挑选的患者再次接触奥沙利铂，无明显并发症。
奥沙利铂诱发的II-HSRs很少见，但带来诊断和管理挑战。本研究显示了早期识别的重要性、DDAbs检测的潜在作用以及在选定患者中在可控条件下再次接触药物的可行性。
