Situation: The nurse works in a hospital chemotherapy day unit that treats adults with solid tumors. A 57-year-old man with colon cancer is receiving his first oxaliplatin infusion. Shortly after drinking iced water, he says his throat feels tight and it is hard to swallow. His voice is normal, and he has no stridor, wheeze, rash, or lip swelling. His blood pressure is 126/80 mmHg and his oxygen saturation is 98% on room air. What should the nurse do?

Oxaliplatin can cause acute throat dysesthesia, a cold-triggered sensory neuropathy that feels like throat tightness or difficulty swallowing. With a normal voice and no stridor, wheeze, rash, swelling, hypotension, or desaturation, this is not anaphylaxis. The nurse reassures him and has him avoid cold drinks and objects; he is still watched for true hypersensitivity, which oxaliplatin can also cause.

Clinical situation
A 57-year-old man receiving his first oxaliplatin infusion reports throat tightness and difficulty swallowing immediately after drinking iced water. His voice is normal, and there is no stridor, wheeze, rash, lip swelling, hypotension, or desaturation. The priority is to recognize this as a cold-triggered sensory phenomenon rather than anaphylaxis.

Why the answer is reassurance and warm drinks
Oxaliplatin causes a distinctive acute, cold-sensitive neurotoxicity. Within hours of infusion, exposure to cold can trigger paresthesias, jaw tightness, and a sensation of throat or laryngeal tightness ^[2]. The underlying mechanism is transient peripheral nerve hyperexcitability, not mucosal edema or bronchospasm. Because the patient’s voice is normal and there is no stridor, wheeze, rash, swelling, hypotension, or oxygen desaturation, the presentation does not meet criteria for anaphylaxis. The correct nursing action is to reassure the patient and advise avoidance of cold drinks and cold objects while continuing to monitor for true hypersensitivity.

Distinguishing acute dysesthesia from anaphylaxis
Oxaliplatin can cause both acute cold-triggered dysesthesia and true hypersensitivity reactions, so the nurse must differentiate them carefully. The table below compares the key features.

Feature	Cold-triggered dysesthesia	Anaphylaxis
Trigger	Cold drink, cold air, cold object	Drug exposure, often after repeated cycles
Voice	Normal	Hoarse or changed
Stridor or wheeze	Absent	May be present
Rash, urticaria, lip or tongue swelling	Absent	Often present
Blood pressure	Stable	May drop
Oxygen saturation	Normal	May fall
Nursing action	Reassure, remove cold trigger, warm drinks	Stop infusion, emergency airway support, adrenaline

Watch out! The absence of objective airway signs is the key discriminator. A sensation of throat tightness alone, with a normal voice and no stridor, is not an indication for adrenaline or emergency airway equipment.

Why the other options are incorrect
Giving an antihistamine and continuing the infusion at the same rate is not indicated because the symptoms are not allergic and continuing cold exposure may worsen the dysesthesia. Stopping the infusion and giving intramuscular adrenaline is inappropriate without evidence of anaphylaxis. Stopping the infusion and preparing for emergency airway support is overly aggressive when the airway is objectively patent.

Clinical monitoring and patient education
The patient should be advised to avoid cold drinks, ice, and cold air for several days after each oxaliplatin infusion because the acute neurotoxicity is transient but reproducible with cold exposure ^[2]. At the same time, the nurse must continue to observe for delayed hypersensitivity reactions, which oxaliplatin can also cause and which may appear after multiple cycles . Reassurance and warm drinks address the immediate symptom, but ongoing surveillance for true hypersensitivity remains essential.