1例预防性使用地塞米松后出现奥沙利铂急性过敏反应的文献复习

One case of acute anaphylaxis induced by oxaliplatin with prophylactic use of dexamethasone: case report and literature review

目的:回顾性分析预防性使用糖皮质激素仍然出现奥沙利铂过敏反应的可能原因及预防措施。方法:回顾性分析奥沙利铂急性过敏反应的可能机制、相关因素及不良反应的预防措施。结果:奥沙利铂急性过敏反应可能是Ig E介导的Ⅰ型过敏反应,年轻、女性、既往应用过奥沙利铂、累积剂量达600 mg·m-2以上、低剂量地塞米松预处理等均是奥沙利铂过敏反应的高危因素,高剂量的地塞米松可降低奥沙利铂再次发生过敏反应的发生率及严重程度。结论:有高危因素的患者在应用奥沙利铂时,应预防性给予高剂量地塞米松和5-HT3受体阻断剂,为避免再次过敏,可使用奥沙利铂脱敏治疗。

Objective： This study was designed to explore the reason and prevention measures of acute anaphylaxis of oxaliplatin with use of dexamethasone in advance. Methods： The pathogenesis, related factors and prevention measures of side effects were analyzed retrospectively. Results： Acute anaphylaxis induced by oxaliplatin may be mediated by Ig E mediated type Ⅰ anaphylaxis, younger, female, already received oxaliplatin, oxaliplatin cumulative dose 600 mg·m^-2 and prophylactic use of low-dose dexamethasone were high risk factors of acute anaphylaxis induced by oxaliplatin. However, the incidence and degree of acute anaphylaxis induced by retreated with oxaliplatin were declined by high-dose dexamethasone. Conclusion： High-dose dexamethasone and 5-hydroxytryptamine-3 antagonist should be used in patients with high risk factors in advance, and acute anaphylaxis could be avoided by oxaliplatin desensitization therapy.