PMID- 36550565
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221226
IS  - 1710-1484 (Print)
IS  - 1710-1492 (Electronic)
IS  - 1710-1484 (Linking)
VI  - 18
IP  - 1
DP  - 2022 Dec 22
TI  - Hypersensitivity reactions to folinic acid: mechanisms involved based on two case 
      reports and a literature review.
PG  - 107
LID - 10.1186/s13223-022-00752-5 [doi]
LID - 107
AB  - BACKGROUND: Hypersensitivity reactions (HSR) to antineoplastic agents are an 
      increasing problem, especially when they lead to treatment discontinuation, 
      sometimes without any equivalent therapeutic option. HSR to folinic acid (FA), 
      used particularly for the treatment of digestive carcinoma along with oxaliplatin 
      and 5-fluorouracil, are rare. Only seven publications report HSR to FA, mainly 
      confirmed by the disappearance of symptoms after the withdrawal of FA from 
      chemotherapy. Only two papers describe allergy testing. Due to the difficult 
      diagnosis, patients usually receive several further cycles of chemotherapy with 
      progressively more intense symptoms before the withdrawal of FA. CASE 
      PRESENTATION: Here we document two cases of HSR to FA, initially misattributed to 
      oxaliplatin. The first patient described successive cycles with first back muscle 
      pain, then chills and facial oedema and finally diffuse erythema with labial 
      edema despite premedication. The allergy assessment highlighted high acute 
      tryptase levels and intradermal tests positive for FA, pointing to an 
      immunoglobulin E (IgE)-mediated mechanism. The second patient also had lower back 
      muscle pain and chills in addition to tachycardia and desaturation during the 
      administration of FA. Skin tests were negative and tryptase levels normal. After 
      withdrawing FA, the symptoms did not recur, thus allowing the patient to continue 
      chemotherapy. The mechanism of FA hypersensitivity is still unclear. The 
      chronology of symptoms suggests an IgE-mediated mechanism that was not documented 
      in the allergy assessment. A non-IgE-mediated mast cell/basophil activation could 
      be involved, through complement activation or through Mas-related G 
      protein-coupled receptors X2 (MRGPRX2) particularly. CONCLUSIONS: These two cases 
      of anaphylaxis to FA document the clinical manifestations associated with two 
      different mechanisms of HSR. This paper provided the opportunity to review the 
      limited literature on HSR to FA. Through these cases, we hope to draw the 
      practitioner's attention to FA as a potential agent of severe hypersensitivity, 
      especially if symptoms remain after withdrawing the most suspected 
      chemotherapeutic agents. We want also to stress the importance of allergy 
      testing.
CI  - (c) 2022. The Author(s).
FAU - Apraxine, Matvei
AU  - Apraxine M
AUID- ORCID: 0000-0002-0133-9255
AD  - Department of Pulmonology, Cliniques Universitaires Saint-Luc, Brussels, Belgium. 
      matvei.apraxine@gmail.com.
AD  - Department of Pulmonology, GHdC, Charleroi, Belgium. matvei.apraxine@gmail.com.
FAU - Van den Eynde, Marc
AU  - Van den Eynde M
AD  - Department of Oncology, Cliniques Universitaires Saint-Luc, Institut Roi Albert 
      II, Brussels, Belgium.
FAU - De Cuyper, Astrid
AU  - De Cuyper A
AD  - Department of Oncology, Cliniques Universitaires Saint-Luc, Institut Roi Albert 
      II, Brussels, Belgium.
FAU - Pirson, Francoise
AU  - Pirson F
AD  - Department of Pulmonology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
AD  - Centre de l'allergie Saint-Luc, Cliniques Universitaires Saint Luc, Brussels, 
      Belgium.
AD  - IREC-PNEU, UCL Universite Catholique de Louvain, Brussels, Belgium.
LA  - eng
PT  - Journal Article
DEP - 20221222
PL  - England
TA  - Allergy Asthma Clin Immunol
JT  - Allergy, asthma, and clinical immunology : official journal of the Canadian 
      Society of Allergy and Clinical Immunology
JID - 101244313
PMC - PMC9783773
OTO - NOTNLM
OT  - Anaphylaxis
OT  - Case report
OT  - Colorectal cancer
OT  - Folinic acid
OT  - Hypersensitivity reaction
COIS- The authors declare that they have no competing interests.
EDAT- 2022/12/23 06:00
MHDA- 2022/12/23 06:01
PMCR- 2022/12/22
CRDT- 2022/12/22 23:57
PHST- 2022/08/24 00:00 [received]
PHST- 2022/12/09 00:00 [accepted]
PHST- 2022/12/22 23:57 [entrez]
PHST- 2022/12/23 06:00 [pubmed]
PHST- 2022/12/23 06:01 [medline]
PHST- 2022/12/22 00:00 [pmc-release]
AID - 10.1186/s13223-022-00752-5 [pii]
AID - 752 [pii]
AID - 10.1186/s13223-022-00752-5 [doi]
PST - epublish
SO  - Allergy Asthma Clin Immunol. 2022 Dec 22;18(1):107. doi: 
      10.1186/s13223-022-00752-5.