title: Management of an anaphylactoid reaction to methotrexate with a stepwise graded challenge.
abstract: We report the management of a 15-year-old boy with an anaphylactic or anaphylactoid response to his first dose of methotrexate during induction therapy for acute lymphoblastic leukemia (ALL). Because weekly methotrexate therapy is an important component of continuation chemotherapy for pediatric ALL, a stepwise graded challenge was employed to achieve drug tolerance.
authors.affiliation: Division of Allergy/Immunology, Children's Hospital, Boston, MA 02446, USA. Andrew.macginnitie@TCH.Harvard.edu
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: MacGinnitie
authors.forename: Loren D
authors.initials: LD
authors.lastname: Walensky
authors.forename: Stuart E
authors.initials: SE
authors.lastname: Turvey
authors.forename: Jordan S
authors.initials: JS
authors.lastname: Orange
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Bonilla
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Silverman
authors.forename: Hans
authors.initials: H
authors.lastname: Oettgen
mesh_terms: D000293:Adolescent; D000707:Anaphylaxis / Q000139:chemically induced* / Q000188:drug therapy; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D000982:Antipruritics / Q000627:therapeutic use; D004155:Diphenhydramine / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D003875:Drug Eruptions / Q000188:drug therapy / Q000209:etiology; D004359:Drug Therapy, Combination; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D011537:Pruritus / Q000139:chemically induced / Q000188:drug therapy; D011899:Ranitidine / Q000627:therapeutic use; D012882:Skin Tests / Q000379:methods*; D014581:Urticaria / Q000139:chemically induced / Q000188:drug therapy
chemical_list: D018926:Anti-Allergic Agents; D000964:Antimetabolites, Antineoplastic; D000982:Antipruritics; D006635:Histamine H2 Antagonists; D011899:Ranitidine; D004155:Diphenhydramine; D008727:Methotrexate