Oxaliplatin-induced severe anaphylactic reactions in metastatic colorectal cancer: Case series analysis

Table 1 Clinical characteristics of patients with life-threatening severe anaphylactic reactions following oxaliplatin chemotherapy (n = 8)

Patient	Sex	Age (yr)	Allergy history	Primary CRC site	TNM classification	Stage	Previous chemotherapy regimens	Previous oxaliplatin chemotherapy cycles	Oxaliplatin dose (mg/m2)	Tumor response	Presenting symptoms	Onset time	Outcome	Rechallenge
1	F	50	Alcohol	Rectum	T4N0M1	IV	FOLFIRI x12, FOLFOX x10	10	85	SD	Consciousness loss, dizziness, shock	30 min	Recovery	No
2	M	71	Nil	Rectum	T2N1M1	IV	FOLFOX x12, FOLFIRI + Bevacizumabx12, FOLFOX x1	13	85	PD	Consciousness loss, shock	20 min	Fatal	No
3	M	36	Nil	Sigmoid colon	T4N2M1	IV	FOLFIRI x13, FOLFOX + Bevacizumab x5, FOLFIRI + Cetuximab x5, FOLFOX x7	12	90	PD	Consciousness loss, respiratory distress, cold sweating	Immediate	Recovery	Yes
4	F	57	Nil	Sigmoid colon	T1N0M1	IV	FOLFIRI x5, FOLFOX x7, FOLFIRI + Bevacizumabx18, FOLFOX + Bevacizumab x1	8	85	PD	Respiratory distress, cold sweating	2 h	Recovery	No
5	F	68	Nil	Sigmoid colon	T3N2M1	IV	FOLFIRI x12, FOLFOX x8	8	85	SD	Angioedema, slurred speech, respiratory distress	30 m	Recovery	No
6	F	72	Nil	Descending colon	T4N1M1	IV	FOLFIRI x7, FOLFOX x3, FOLFIRI x12, FOLFOX x2	5	85	PD	Nausea, vomiting, shock,	10 min	Recovery	No
7	M	59	Flurbiprofen	Rectum	T3N2M1	IV	FOLFOX x19, FOLFIRI x8, FOLFOX x10	29	85	SD	Consciousness loss, respiratory distress, cold sweating	Immediate	Recovery	No
8	M	62	Nil	Sigmoid colon	T3N1M1	IV	FOLFIRI + Bevacizumabx6, FOLFOX x7	7	85	PD	Consciousness loss, respiratory distress, cold sweating	20 min	Recovery	No

M: Male; F: Female; CRC: Colorectal cancer; TNM: Tumor, nodes, metastasis; PD: Progressive disease; SD: Stable disease; FOLFIRI: Chemotherapy regimen including 5-fluorouracil, leucovorin, irinotecan; FOLFOX: Chemotherapy regimen including 5-fluorouracil, leucovorin, oxaliplatin.

Table 2 Studies on severe anaphylactic reactions following oxaliplatin, including data published from 1997 to 2012 in English (24 studies, n = 66)

Ref.	Published year/region	Patient No.	Age (yr)	Male/female	Previous oxaliplatin cycles	Oxaliplatin dose (mg/m2)	Presenting symptoms	Onset time after oxaliplatin infusion	Outcome
de Gramont et al[10]	1997/France	5	NA	NA	NA	NA	NA	NA	Recovery
Tournigand et al[11]	1998/France	5	59-77	3/2	5-12	85-100	Reduced blood pressure, flushing, headache, tachycardia, respiratory distress	Immediate	Recovery
Larzillière et al[12]	1999/France	1	55	1/0	5	85	Flushing, profuse sweats, arterial hypertension, tachycardia	30 min	Recovery
Médioni et al[13]	1999/France	1	63	1/0	6	100	Visual disturbances, edema, tachycardia, severe hypotension, anaphylactic shock	Immediate	Recovery
Sørbye et al[14]	2000/Norway	1	40, 52	1/0	8	85	Severe thrombocytopenia	Immediate	Recovery
Santini et al[15]	2001/Italy	1	52	1/0	6	60	Chills, fever, nausea, vomiting, crampy abdominal pain, diarrhea, hypotension	15 min	Recovery
Schüll et al[16]	2001/Austria	1	54	1/0	5	85	Flush, generalised erythema of the trunk, nausea, hypotension	30 min	Recovery
Brandi et al[17]	2003/Italy	9	NA	NA	2-17	NA	Dyspnea, laryngospasm, agitation, tachycardia, precordial pain, erythema, sweating	NA	Recovery
Thomas et al[18]	2003/United States	1	50	0/1	9	NA	Fever, respiratory distress	2 h	Recovery
Lenz et al[19]	2003/Germany	2	NA	NA	NA	85	Severe abdominal, chest pain.	Immediate	Recovery
Bhargava et al[20]	2004/United States	1	50	0/1	12	NA	Palpitation, flushing, hypotensive, wheezing	15 min	Recovery
González-Mahave et al[21]	2005/Spain	2	43, 44	1/1	4, 11	NA	Respiratory collapse, fever	Immediate	Recovery
Maindrault-Goebel et al[22]	2005/France	3	NA	NA	NA	NA	Anaphylactic shock	NA	Recovery
Siu et al[8]	2006/Hong Kong	2	NA	NA	NA	100	Hypotension, oxygen desaturatio, full-blown anaphylactic reactions	NA	NA
Tze et al[23]	2006/China	1	60	0/1	12	NA	Anaphylactic shock	Immediate	Recovery
Lee et al[24]	2006/Taiwan	4	36-74	NA	6-7	85-100	Anaphylactic shock, hypertensive crisis	5-50 min	Recovery
Yanqi et al[25]	2007/China	1	52	1/0	6	150 mg	Anaphylactic shock	10 min	Recovery
Santodirocco et al[26]	2008/Italy	1	44	0/1	14	85	Acute thrombocytopenia, hemolysis, bleeding	1 h	Recovery
Shao et al[27]	2008/Taiwan	1	64	1/0	23	NA	Thrombocytopenia	1 h	Fatal
Chay et al[9]	2010/Singapore	11	36-75	4/7	NA	NA	Respiratory collapse, flushing, hypokalemia	NA	Recovery
Pietrantonio et al[28]	2010/Italy	1	NA	NA	NA	NA	Acute thrombocytopenia	NA	Recovery
Potenza et al[29]	2010/Italy	1	46	1/0	6	85	Respiratory collapse	10 h	Recovery
Teng et al[30]	2011/Taiwan	1	78	1/0	17	85	Pancytopenia, coagulopathy, intracranial hemorrhage	30 min	Fatal
Wang et al, this study	2012/Taiwan	7	36-72	3/4	5-29	85-90	Consciousness loss, chest tightness, cold sweating, nausea, vomiting, shock	immediately to 2 h	1 fatal

NA: Not applicable.