Repeated exposure to platinum compounds increases the risk of immunoglobulin E-mediated immediate hypersensitivity reactions (HSR). To date, many different desensitization protocols with varying success rates have been reported. 

A 3-year retrospective review of patients referred to Ege University Hospital with carboplatin- or oxaliplatin-induced HSR was performed. An allergy and immunology specialist obtained the history of the patient's HSR and performed skin tests to decide the appropriate desensitization protocol. Standard (12-step) or prolonged (16-step) desensitization protocols were selected as previously described. The protocol was conveyed to a clinical pharmacist, who calculated the drug concentrations and alerted the robotic chemotherapeutic preparation unit while simultaneously conveying the detailed step by step protocol, including drug concentrations and application times, to the physicians and nurses in the intensive care unit where the drug will be administered under the supervision of the specialist. When deemed necessary by the specialist, the desensitization protocol was modified by the pharmacist to allow a lower infusion rate in the last step. Here we define 6 patients (4 carboplatin, 2 oxaliplatin) who completed their chemotherapy regimen with desensitization. 

All the patients were premedicated with pheniramine 45.5 mg, famotidine 20 mg, montelukast 10 mg, dexamethasone 20 mg, and ondansetron 8 mg. Patient #1 and #2 (carboplatin), and Patient #5 (oxaliplatin) did not experience any HSR during 15 desensitization courses. None of the patients experienced laryngeal edema or gastrointestinal symptoms. Patients #3, #4, and #6 had grade 1-3 HSRs which were successfully managed by oxygen and/or pharmacological interventions (Table 1) and infusion was completed at a lower rate after stabilization of the patient. Compared to baseline, serum tryptase levels were elevated during HSRs (4.74±0.21 vs 9.50±1.71, P<0.05 Wilcoxon Signed Ranks Test). All of the patients were able to complete their chemotherapy regimen. 

The interdisciplinary approach facilitated the management of problems during the robotic preparation and administration of chemotherapeutics in the intensive care unit. Interdisciplinary teams may increase the success rates of desensitization protocols for platinum-based chemotherapy, where the concentration and application of drugs differ from standard procedures.