6 Syrigou et al. (2009) [58] Castells et al. (2008) [53] Nozawa et al. (2008) [59] Wrzesinski et al. (2007) [60] Edmondson et al. (2007) [61] Herrero et al. (2006)[62] Mis et al. (2005) [63] Lim et al. (2004) [64] Gammon et al. (2004) [65] Schu¨ll et al. (2001) [66] 3 1 1 1 1 5 1 1 1 1 None Diphenhydramine or hydroxyzine 25 mg po or iv, famotidine 20 mg iv or ranitidine 50 mg iv, lorazepam (0.5−1 mg po or iv as needed for anxiety) Famotidine 20 mg iv QD, Dexamethasone 20 mg iv QD, diphenhydramine 50 mg po QID, domperidone 10 mg po QID, hydrocortisone 100 mg iv QD, granistron 3 mg iv QD Famotidine 20 mg iv BID, Dexamethasone 20 mg iv QD, diphenhydramine 50 mg iv QD, magnesium sulfate 1 g iv BID, calcium gluconate 1 g iv BID, ondasetron 8 mg iv BID None None Dexamethasone 20 mg iv, prednisolone 20 mg po QID, diphenhydramine 50 mg iv, cimetidine 300 mg iv, magnesium sulfate 1 g iv, calcium gluconate 1 g iv, ondasetron 8 mg iv Diphenhydramine 50 mg po QID and 30 mg iv QD, metoclopramide 9 mg iv QD Dexamethasone iv, hydrocortisone 100 mg iv, diphenhydramine iv Dexamethasone iv (high dose), antihistamine iv, ondasetron 8 mg iv Table 6: Published desensitization protocols for oxaliplatin hypersensitivity. We observe that almost all protocols deliver the platinum agent at escalating concentrations and administer premedication. Patients Premedication-Dose-Route BID: twice a day, iv: intravenously, po: by mouth, QD: once a day, QID: four times a day. of women with ovarian cancer, therefore, its eﬃcacy, and safety remain to be proven in other populations as well [53]. It should be noted that there have also been reports of successful desensitization in children [95]. Risks and beneﬁts of desensitization protocols must be carefully weighed, and patients should be informed of the danger as there is still risk of anaphylaxis, or even death during the platinum rechallenge [89, 90, 96]. 6.3. Substituting with a Diﬀerent Platinum Agent. Substi- tuting one platinum agent with another without additional desensitization is another management option available in case of hypersensitivity [32, 97–100]. Successful replacement of carboplatin by cisplatin has been demonstrated in women with gynecological malignancies [57, 101] but the true incidence of cross-reactivity between platinum salts is not yet known. The possibility of developing a reaction to the substituting platinum agent may be as high as 25% [101], and cases of fatal cisplatin reactions after carboplatin hypersensitivity have been reported [89, 102]. 6.4. Skin Testing. Skin testing has been used in an eﬀort to predict hypersensitivity reactions in patients about to be re-administered platinum salts [30, 103]. Markman et al. reported that skin tests had been positive in six of seven patients who later developed anaphylaxis during carboplatin readministration [103], thus, suggesting that hypersensitivity reactions can be predicted. Zanotti et al. [30] used similar Steps From 1 : 100000 to 1 : 1 in 13 steps From 1 : 100 to 1 : 1 in 12 steps From 1 : 10000 to 1 : 1 in 5 steps From 1 : 10000 to 1 : 1 in 5 steps From 1 : 10000 to 1 : 2 in 12 steps From 0.003 to 0.75 mg/min in several steps From 1 : 10000 to 1 : 1 in 5 steps Continuous ﬁxed rate 24 hours From 1 : 10000 to 1 : 1 in 5 steps Continuous ﬁxed rate 8 hours 48 hours Metal-Based Drugs Duration 8 hours Success rate 100% 5.8 hours 100% 8 hours 100% 6 hours 100% 205 minutes 5-6 hours 8 hours 100% 100% 100% 100% 100% 100%