奥沙利铂过敏反应临床特征的研究

  目的  通过分析结直肠癌患者使用含奥沙利铂方案化疗前常规行地塞米松5 mg预处理后过敏反应发生的临床特征，为降低奥沙利铂过敏风险提供参考依据。  方法  回顾性分析2014年1月至2017年10月苏州大学附属常州肿瘤医院收治的242例含奥沙利铂方案化疗的结直肠癌患者临床资料，统计过敏反应发生率，对多项因素与过敏反应关系进行单因素分析，采用Logistic多因素回归模型分析影响过敏反应发生的独立因素，并探讨奥沙利铂过敏患者再次使用奥沙利铂治疗的结局。  结果  242例结直肠癌患者使用含奥沙利铂方案化疗前行地塞米松5 mg静推，发生过敏反应12例（4.9%），均为Ⅰ型过敏反应，中位发生时间6（5.5~ 10.5）个周期，中位累积剂量895（716.5~1 075.0）mg。多因素分析提示存在无奥沙利铂间隔期为过敏反应的独立预测因素（P= 0.04）。其中3例奥沙利铂过敏患者接受药物预处理后再次使用奥沙利铂，1例（33.3%）成功完成治疗。  结论  奥沙利铂使用前常规行小剂量地塞米松预处理，过敏反应发生率低于文献报道，安全性高，无奥沙利铂间隔期患者再次使用该药过敏反应发生率明显提高，奥沙利铂过敏患者再次使用需谨慎。 

Clinical analysis of hypersensitivity reactions to oxaliplatin

  Objective  To analyze the clinical characteristics of allergic reactions in patients with colorectal cancer after routine premedication with dexamethasone (5 mg) before chemotherapy with an oxaliplatin-containing regimen and to provide a reference for reducing the risk of oxaliplatin allergy.  Methods  Retrospective analysis of 242 patients with colorectal cancer who received chemotherapy with an oxaliplatin-containing regimen at the Changzhou Cancer Hospital of Soochow University from January 2014 to October 2017 was performed, and the incidence of allergic reactions was calculated. The associations between multiple factors and allergic reactions were then assessed using univariate analysis. The independent factors of allergic reactions were assessed using multivariate Logistic analysis, and the treatment outcome of oxaliplatin rechallenge in allergic patients was discussed.  Results  A total of 242 patients were studied. They received routine premedication with dexamethasone (5 mg) before chemotherapy with an oxaliplatin-containing regimen. Twelve (4.9%) patients had type Ⅰ allergic reactions, with a median onset time of 6 (5.5-10.5) cycles and a median cumulative dose of 895 (716.5-1 075.0) mg. Multivariate analysis identified undergoing an oxaliplatin-free interval as an independent risk factor (P=0.04). Rechallenging patients with prophylactic agents was successful in 1 (33.3%) of 3 patients who completed their treatment.  Conclusions  Routine low- dose dexamethasone premedication before oxaliplatin administration is safe and exhibited a lower incidence of hypersensitivity reactions than that reported in literature. An oxaliplatin-free interval may increase the risk of hypersensitivity reactions. Caution should be exercised while rechallenging allergic patients with oxaliplatin.