1. Incidence Rate of Infusion or Hypersensitivity Reactions

  • Overall incidence of hypersensitivity reactions (HSRs) to oxaliplatin: ranges from 2% to 25% depending on cumulative exposure and patient population.
  • Grade 3–4 severe reactions: occur in approximately 1.6%–2.3% of patients.
  • Timing: HSRs typically occur after multiple treatment cycles — most commonly after the 6th cycle or later — due to repeated antigen exposure and sensitization.

2. Onset, Signs, and Symptoms of Reactions

Onset:

  • Most infusion-related reactions (IRRs) occur during the infusion or within minutes to hours following administration.
  • Immediate reactions: usually within the first 30 minutes of infusion.
  • Delayed reactions: can occur up to several hours after infusion.

Signs and Symptoms:

  1. Mild to Moderate (Grade 1–2):
    • Flushing
    • Rash, pruritus
    • Urticaria
    • Mild hypotension or hypertension
    • Fever and chills
    • Dyspnea without bronchospasm
  2. Severe (Grade 3–4):
    • Bronchospasm, chest tightness
    • Laryngeal edema, throat tightness
    • Anaphylaxis (with hypotension, tachycardia, generalized urticaria, collapse)
    • Severe hypotension or shock

3. Prophylactic Medications (Given 30–60 minutes prior to infusion)

Although routine premedication is not universally required for all first-time oxaliplatin recipients, prophylactic regimens are recommended in patients at higher risk or with prior mild reactions, or when continuing therapy after desensitization.Common prophylactic options:

  • Corticosteroids:
    • Dexamethasone 8–20 mg IV (commonly given as part of the antiemetic regimen)
  • H1 Antihistamines:
    • Diphenhydramine 25–50 mg IV
    • or Cetirizine 10 mg orally (less sedating option; may be given prior to arrival)
  • H2 Antagonists:
    • Ranitidine 50 mg IV
    • or Famotidine 20 mg IV
  • Optional (especially with prior reactions):
    • Acetaminophen 650 mg orally to reduce fever/chills risk

4. Management Strategies for Infusion Reactions Specific to Oxaliplatin

A. If Reaction Occurs During Infusion:

  1. Immediately stop the infusion; maintain IV access.
  2. Assess airway, breathing, circulation (ABCs).
  3. Administer oxygen and monitor vital signs closely.
  4. Pharmacologic interventions:
    • Epinephrine (0.3–0.5 mg IM, 1:1000 concentration) for anaphylaxis.
    • Antihistamines: diphenhydramine 25–50 mg IV.
    • Corticosteroids: dexamethasone or methylprednisolone IV bolus.
    • H2 antagonists: famotidine or ranitidine IV.
    • Bronchodilators for bronchospasm (e.g., albuterol via nebulizer).
  5. IV fluids for hypotension and shock.
  6. If symptoms resolve, discuss risk/benefit of rechallenge versus discontinuation.

B. Rechallenge Protocols (for mild/moderate reactions):

  • May be considered in selected patients after risk assessment.
  • Slower infusion rate (e.g., extend to 6 hours or more).
  • Escalating dose desensitization protocols under close supervision in specialized centers.
  • Premedication with steroid + H1/H2 antihistamines before subsequent doses.

C. Discontinuation Criteria:

  • Grade 3–4 life-threatening reactions or confirmed anaphylaxis are generally considered absolute indications to permanently discontinue oxaliplatin.

Key Monitoring Recommendations

  • First 15–30 min of infusion: highest vigilance.
  • Have emergency resuscitation drugs and equipment readily available.
  • Educate patients to report symptoms immediately — even subtle sensations (throat tightness, itching, chest pressure).
Oxaliplatin Hypersensitivity Reaction Management Flowchart
https://info.pharkeep.com/oxaliplatin-reaction.html
PharKeep DigestKevin Van, PharmD, BCPS (Editor)

References

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  2. Maindrault-Goebel F, et al. “Allergic-type reactions to oxaliplatin: retrospective analysis.” Eur J Cancer. 2005;41(15):2262-2267.
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