{
  "abstract": "Background: Rapid drug desensitization permits continued chemotherapy, but no validated blood measurement predicts breakthrough reactions during desensitization.\n\nObjective: To compare paired plasma metabolomic and lipidomic changes during chemotherapy desensitization with those in tolerant controls, and to describe breakthrough and omalizumab encounters.\n\nMethods: In this pilot study, 10 patients undergoing carboplatin or paclitaxel desensitization and four tolerant controls receiving standard infusions contributed 76 draws across 39 encounters (37 with paired pre- and post-infusion draws). Untargeted liquid chromatography-mass spectrometry in four modes yielded 8,646 quality-filtered features (instrument signals). Exact permutation with false discovery rate control compared patient-averaged paired changes from 27 allergic encounters (10 patients) off omalizumab with four control encounters (four patients). Breakthrough and omalizumab comparisons were descriptive.\n\nResults: Allergic patients’ profiles changed from pre- to post-infusion in three of four modes (Holm-adjusted P = .04). Pre-infusion profiles differed between allergic patients and controls in one mode (Holm-adjusted P = .02). Montelukast, a premedication drug, had the smallest P value among annotated pre-infusion differences and was detected in all 33 allergic and no control pre-infusion draws. No feature distinguished allergic from control paired changes at a 5% false discovery rate. Histamine did not consistently increase in seven paired breakthrough encounters (five patients). Hemolysis was more frequent in allergic post-infusion than pre-infusion draws (16 of 35 vs eight of 33).\n\nConclusion: Profiling during desensitization detected premedication exposure and broad pre-to-post changes largely shared with controls, but no allergy-specific signature. Prospective studies need sampling timed to reactions and medications, comparators matched for premedication and infusion duration, and standardized specimen handling.\n\nHighlights Box: What is already known about this topic?: Desensitization lets most patients with carboplatin or paclitaxel hypersensitivity continue treatment. Breakthrough reactions occur, and no validated blood measurement predicts them.\n\nWhat does this article add to our knowledge?: In 14 patients, plasma profiling detected premedication signals before infusion and broad pre-to-post changes; no feature distinguished allergic from control changes at a 5% false discovery rate. Histamine did not consistently rise with breakthrough reactions.\n\nHow does this study impact current management guidelines?: Biomarker studies during chemotherapy desensitization should match comparators for premedication, time blood draws to symptom onset, and standardize specimen processing; these exploratory findings do not change current desensitization practice.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
      "name": "Amir Asiaee",
      "orcid": "0000-0002-5317-9820"
    },
    {
      "name": "Stacy D. Sherrod"
    },
    {
      "name": "Simona G. Codreanu"
    },
    {
      "name": "Katrina L. Leaptrot"
    },
    {
      "name": "Alexandra C. Schrimpe-Rutledge"
    },
    {
      "name": "John A. McLean"
    },
    {
      "name": "Micah A. McGinnis"
    },
    {
      "name": "Halle C. Petrie"
    },
    {
      "name": "Lauren S. Prescott"
    },
    {
      "name": "Alaina J. Brown"
    },
    {
      "name": "Ronald Alvarez"
    },
    {
      "name": "Elizabeth J. Phillips"
    },
    {
      "name": "Cosby A. Stone"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3q87e4pwa3wv4.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.30.26366681",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366681v1.full",
  "id": "3q87e4pwa3wv4",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366681v1",
  "language": "en",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Article"
    ],
    [
      "medrxiv",
      "allergy and immunology"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366681v1.full.pdf",
  "pmcid": "PMC13734184",
  "pmid": "42990658",
  "published": "2026-10-30",
  "publisher": "Cold Spring Harbor Laboratory Preprints",
  "ris": "https://research.draconitic.com/paper/3q87e4pwa3wv4.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:43Z",
      "native_id": "10.64898/2026.10.30.26366681",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366681v1"
    },
    {
      "first_seen": "2026-11-08T12:23:49Z",
      "native_id": "PMC13734184",
      "source": "pmc",
      "url": "https://doi.org/10.64898/2026.10.30.26366681"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:allergy and immunology",
      "subfield": "general"
    }
  ],
  "title": "Plasma Metabolomics During Chemotherapy Desensitization: A Pilot Study",
  "title_text": "Plasma Metabolomics During Chemotherapy Desensitization: A Pilot Study",
  "type": "preprint",
  "updated_at": "2026-11-08T12:23:49Z",
  "url": "https://research.draconitic.com/paper/3q87e4pwa3wv4",
  "venue": "medRxiv",
  "versions": []
}