Ondansetron hypersensitivity: a clinical diagnosis protocol and cross-reactivity study

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Cutaneous adverse drug reactions during chemotherapy: consider non-antineoplastic drugs.

Cutaneous adverse drug reactions (CADR) during chemotherapy are not rare, but difficult to manage. Case 1, a 49-year-old man was treated with 5-fluorouracil, irinotecan, and oxaliplatin for a pancreatic tumour. He developed a generalized urticaria during his seventh course of chemotherapy. 2 months later, skin tests determined a granisetron allergy with an ondansetron cross-reaction. Substituting the anti-emetic allowed continuation of the chemotherapy. Case 2, a 44-year-old woman, having recurring breast cancer that was treated with doxorubicin, and docetaxel developed a maculo-papular rash (MPR) the day after the first chemotherapy treatment. 2 weeks later, skin tests determined a corticosteroid class A allergy. Using a class C corticosteroid, no other reaction occurred. Case 3, a 44-year-old woman, having breast cancer treated with 5-fluorouracil, cyclophosphamide, and epirubicin developed an MPR after the second chemotherapy treatment. 12 days later, skin tests showed a granisetron allergy. Using alizapride, chemotherapy was continued with no further reaction. CADR necessitate a thorough investigation, modified according to the patient's chemotherapy treatment chronology and precautions while testing the molecules. Tests are rarely carried out, however, these tests allow for continuation of effective chemotherapy once the responsible agent has been determined. The 3 cases reported underline the role of complementary treatment and the necessity to test those molecules.

A sensitive radioimmunoassay, combined with solid-phase extraction, for the sub-nanogram per ml determination of ondansetron in human plasma.

The development of a radioimmunoassay, incorporating solid-phase sample extraction, suitable for the subnanogram per ml determination of ondansetron base in human plasma is described. The antiserum was raised in Soay sheep following primary and booster immunizations with an immunogen prepared by conjugating 9-(carboxypropyl)-ondansetron to bovine thyroglobulin. The radioligand consisted of ondansetron specifically tritium-labelled on the N-methyl group of the indole moiety. The solid-phase extraction method, using a cyanopropyl sorbent, was introduced to remove cross-reacting metabolites and to enhance assay sensitivity. The calibration range is 0.05-2.40 ng ml-1 using a 1 ml sample of human plasma; inter- and intra-assay bias and precision are < +/- 13% and < 10% over this concentration range, respectively. The assay drift, measured as the difference in concentration values for quality control samples assayed immediately before and after the sequence of test plasma samples, is < +/- 10% for run sizes of up to 54 samples.