title: Alternative algorithm for L-asparaginase allergy in children with acute lymphoblastic leukemia.
abstract: BACKGROUND
  L-asparaginase is a crucial chemotherapeutic agent for the treatment of acute lymphoblastic leukemia. The alternatives to L-asparaginase are not available in many parts of the world, including Turkey.
  
  
  OBJECTIVE
  We sought to evaluate the utility of premedication with or without a desensitization protocol in children with acute lymphoblastic leukemia and systemic hypersensitivity reactions to Escherichia coli-asparaginase.
  
  
  METHODS
  In this prospective study patients with systemic hypersensitivity reactions to E coli-asparaginase for whom we were unable to ascertain/provide other alternatives to asparaginase were either premedicated, desensitized, or both to receive their chemotherapy as E coli-asparaginase according to the severity of the hypersensitivity reaction.
  
  
  RESULTS
  Nineteen patients (13 male patients) with a mean age of 7.4 +/- 4.7 years experienced a systemic hypersensitivity reaction to E coli-asparaginase during a 4-year period. Polyethylene glycol-asparaginase could be used for 3 patients. Eight of the remaining 16 children, who had experienced anaphylaxis, were premedicated and desensitized with E coli-asparaginase, and in 7 patients treatment was tolerated. The other 8 patients, with acute allergic reactions to E coli-asparaginase, were premedicated first, and 5 of them showed no reaction subsequently. Three of them demonstrated systemic hypersensitivity reactions again (anaphylaxis, n = 3), and premedication and desensitization with E coli-asparaginase resulted in anaphylaxis. Polyethylene glycol-asparaginase was administered uneventfully to the patients who could be provided it.
  
  
  CONCLUSIONS
  E coli-asparaginase could be administered to more than half of the patients who had a hypersensitivity reaction, and all of these patients were able to receive their planned doses of asparaginase. In countries with shortages of alternative asparaginase preparations, our approach might be a suitable option.
authors.affiliation: Pediatric Allergy and Asthma Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Ozge Uysal
authors.initials: OU
authors.lastname: Soyer
authors.forename: Selin
authors.initials: S
authors.lastname: Aytac
authors.forename: Ayfer
authors.initials: A
authors.lastname: Tuncer
authors.forename: Mualla
authors.initials: M
authors.lastname: Cetin
authors.forename: Sevgi
authors.initials: S
authors.lastname: Yetgin
authors.forename: Bulent Enis
authors.initials: BE
authors.lastname: Sekerel
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001215:Asparaginase / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004342:Drug Hypersensitivity / Q000209:etiology*; D004926:Escherichia coli / Q000201:enzymology*; D005260:Female; D006801:Humans; D008297:Male; D011092:Polyethylene Glycols / Q000009:adverse effects; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011446:Prospective Studies
chemical_list: D000970:Antineoplastic Agents; D011092:Polyethylene Glycols; C042705:pegaspargase; D001215:Asparaginase