Folinic acid
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Anaphylactic reaction in an elderly patient: case report A 67-year-old woman with colon cancer developed anaphylactic reactions during treatment with folinic acid as part of mFOLFOX chemotherapy [dosage and time to reaction onset not stated]. The woman started receiving mFOLFOX-6 plus cetuximab as first-line therapy. During the first 18 cycles, she developed grade 1 peripheral neuropathy, nausea, fatigue and diarrhoea. However, she felt hot during at the start of the cetuximab infusion during the next cycle, and experienced facial flushing, dyspnoea, cough, hypertension and vomiting; folinic acid [leucovorin], oxaliplatin and fluorouracil had already been administered. The woman received hydrocortisone, diphenhydramine, famotidine, pethidine and ondansetron. Supplementary oxygen was initiated, and she was transferred to an emergency department. A cetuximab-induced reaction was suspected, and the drug was replaced with panitumumab. FOLFOX was administered after premedication with dexamethasone. During the subsequent panitumumab infusion, flushing, acute diarrhoea and a burning sensation all over her body recurred. The reaction resolved with diphenhydramine, hydrocortisone and famotidine. Two weeks later, it was decided to continue with FOLFOX alone and to space out the folinic acid and oxaliplatin administrations. She was premedicated with granisetron and dexamethasone, and developed flushing, dyspnoea, chest heaviness, hypotension of 90/60mm Hg and vomiting at the end of the folinic acid infusion (1.35 hours); lung auscultation revealed few crackles at the lung bases. The folinic acid infusion was discontinued, and she received hydrocortisone, diphenhydramine, albuterol and epinephrine [adrenaline]. Pethidine was then administered for rigors, and she was transferred to an emergency department for observation. She recovered, but experienced grade 2 diarrhoea. She was subsequently treated with capecitabine, which was associated with grade 1 erythrodysaesthesia. Due to grade 2 peripheral neuropathy, she was not rechallenged with oxaliplatin. Author comment: "It was presumed that the patient had an anaphylactic reaction secondary to [folinic acid] in the chemotherapy for colon cancer." Katirtzoglou NA, et al. Anaphylactic reaction associated with intravenous administration of folinic acid in a patient with colon cancer. In Vivo 25: 995-996, 803066002 No. 6, Dec 2011 - Greece
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Reactions 21 Jan 2012 No. 1385
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