In vivo Assay and Serum Tryptase Assay in Diagnostic Reaction Access to Chemotherapeutic Preparations

Postgraduate Thesis uoadl:2878277 272 Read counter

Unit:
Κατεύθυνση Σύγχρονη Διαγνωστική στη Δερματολογία-Αφροδισιολογία και Αλλεργιολογία
Library of the School of Health Sciences
Deposit date:
2019-07-10
Year:
2019
Author:
Rotsiamis Nikolaos
Supervisors info:
Ρηγόπουλος Δημήτριος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Κατούλης Αλέξανδρος, Αν. Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Βρυώνη Γεωργία, Αν. Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Αξιολόγηση in vivo δοκιμασιών και τρυπτάσης ορού στην διαγνωστική προσπέλαση αντιδράσεων σε χημειοθεραπευτικά σκευάσματα
Languages:
Greek
Translated title:
In vivo Assay and Serum Tryptase Assay in Diagnostic Reaction Access to Chemotherapeutic Preparations
Summary:
Introduction: The emergence of a spectrum of hypersensitivity reactions in prescriptions and in particular in chemotherapeutic prescriptions is a challenge to the medical and scientific field. The platinum derivatives (carboplatin, oxaloplatin, cisplatin) are widely used as chemotherapeutic agents in numerous primary and secondary tumors with an increasing incidence of immediate reactions, sometimes very serious. Serum tryptase is the most useful laboratory test for anaphylaxis assessment, and its elevated levels have been detected in subgroups of patients with mastocytosis, myelodysplastic syndrome, myeloplastic neoplasmosis, acute myeloid leukemia, chronic myeloid leukemia and chronic eosinophilic leukemia. The main objective of our study is the valid assessment to avoid the above observed reactions to widely used chemotherapeutic medicinal products.
Aim: The aim of the present study is to evaluate the skin tests and the measurement of serum tryptase in the diagnostic approach of immediate hypersensitivity reactions to chemotherapeutic agents.
Patients: This study evaluated patients who experienced hypersensitivity reactions during the injection of chemotherapeutic agents or at the end of six hours. The design of the study included a detailed record of the clinical symptom of hypersensitivity reactions, the recording of the individual booster, the measurement of serum tryptase 60-180 minutes after the reaction and the skin tests (Skin Prick Tests and Ids) with non-irritating concentrations of the responsible (carboplatin, oxaloplatin, cisplatin) 15-20 days after the reaction.
Results: The study included 70 patients who developed hypersensitivity reactions in platinum derivatives. Of these, 25 were male (35.7%) and 45 women (64.3%). The mean age of patients was 60.9 ± 9.9 years from 32 to 84 years (median 60). The observed responses were 37/70 (52.8%) to carboplatin, 23/70 (33%) to oxaliplatin and 10/70 (14.2%) to cisplatin. In the reported 70 hypersensitivity reactions, the most frequent systems were the skin at 90%, the respiratory system at 57.1%, the cardiovascular system at 30%, and the gastrointestinal system at 42.8%. An increase in the tryptase response rate compared to the baseline was demonstrated, with an average of 6.6 ± 8.1 μg/L from 0.5 to 34.1 (median 4.3). No correlation of the severity of the hypersensitivity reaction with the positive skin tests was demonstrated in the study population and in any of the formulations tested (p = 0.24).
Conclusion: Measuring the tryptase response compared to baseline is a handy and reliable index of rash in the platinum derivatives. Dermal tests, when performed in an appropriate manner, provide important information about the response mechanism and decision on further therapeutic treatments, but are not related to the severity of the initial reaction.
Main subject category:
Health Sciences
Keywords:
Tryptase, Hypersensitivity reactions, Anaphylaxis, Sensitization, Chemotherapeutic medicines
Index:
Yes
Number of index pages:
2
Contains images:
Yes
Number of references:
215
Number of pages:
96
File:
File access is restricted only to the intranet of UoA.

Διπλωματική ΡΩΤΣΙΑΜΗΣ ΝΙΚΟΛΑΟΣ (F).pdf
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