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Oxaliplatin-induced hypersensitivity reaction displaying marked elevation of immunoglobulin E
Noriaki Kitada, MS
Department of Hospital Pharmacy, Takarazuka Municipal Hospital; 4-5-1 Kohama, Takarazuka, Hyogo 665-0827, Japan, Department of Hospital Pharmacy, Faculty of Pharmaceutical Sciences, Kyoto Pharmaceutical University; 5 Nakauchi-cho, Misasagi, Yamashinaku, Kyoto 607-8414, Japan, nkitada{at}poppy.kyoto-phu.ac.jp
Toshiyuki Dan, MD
Department of Surgery, Takarazuka Municipal Hospital; 4-5-1 Kohama, Takarazuka, Hyogo 665-0827, Japan
Kohji Takara, PhD
Department of Hospital Pharmacy, Faculty of Pharmaceutical Sciences, Kyoto Pharmaceutical University; 5 Nakauchi-cho, Misasagi, Yamashinaku, Kyoto 607-8414, Japan
Takashi Tsuji, BS
Department of Hospital Pharmacy, Takarazuka Municipal Hospital; 4-5-1 Kohama, Takarazuka, Hyogo 665-0827, Japan
Hajime Yamasaki, MD
Department of Surgery, Takarazuka Municipal Hospital; 4-5-1 Kohama, Takarazuka, Hyogo 665-0827, Japan
Teruyoshi Yokoyama, PhD
Department of Hospital Pharmacy, Faculty of Pharmaceutical Sciences, Kyoto Pharmaceutical University; 5 Nakauchi-cho, Misasagi, Yamashinaku, Kyoto 607-8414, Japan
Masakatsu Watari, BS
Department of Hospital Pharmacy, Takarazuka Municipal Hospital; 4-5-1 Kohama, Takarazuka, Hyogo 665-0827, Japan
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. J Oncol Pharm Practice (2007) 13: 233—235.
Key Words: oxaliplatin • FOLFOX • hypersensitivity reaction • anaphylaxis • immunoglobulin E
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Journal of Oncology Pharmacy Practice, Vol. 13, No. 4,
233-235 (2007)
DOI: 10.1177/1078155207079877
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