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Diagnostic Tests in Hypersensitivity to Oxaliplatin Beyond Clinical History
Saturday, March 5, 2016
South Exhibit Hall H (Convention Center)
Paula Lopez-Gonzalez, MD, Ricardo Madrigal-Burgaleta, MD, Pilar Berges-Gimeno, PhD, Emilio Solano-Solares, MD, Laura Carpio-Escalona, MD, Emilio Alvarez-Cuesta, MD PhD
Rationale:

Drug provocation test (DPT) with oxaliplatin is considered in some review articles but previous works do not clearly show data about DPT with this drug.

Our objective is to assess the usefulness of including DPT as an important diagnostic tool in oxaliplatin hypersensitivity.

Methods:

A prospective, observational, longitudinal study was carried out including patients who, during a 3-year period, had suffered a hypersensitivity reaction to oxaliplatin at the Ramon y Cajal University Hospital and had been referred to our Allergy Division's Desensitization Program.

Additionally, we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios for skin tests and oxaliplatin-specific IgE.

Results:

74 oxaliplatin-reactive patients were assessed. 41 (55%) patients underwent DPT. 59% of all DPTs were negative. Only one patient suffered a severe reaction during DPT.  

Sensitivity for oxaliplatin-specific IgE (0.35UI/L cut-off point) was 34%, specificity 90.3%, PPV 85%,NPV 45.9%, negative likelihood ratio 0.7 and positive likelihood ratio 3.5.

Conclusions:

DPT is of vital importance as a diagnostic tool for excluding oxaliplatin hypersensitivity (59% were negative) and therefore avoiding desensitization to non-hypersensitive patients.

Whenever positive, skin tests and oxaliplatin-specific IgE could be useful  to confirm oxaliplatin hypersensitivity.

Whenever negative, skin tests and oxaliplatin-specific IgE seem less useful and need DPT to achieve a diagnosis.