title: Retrospective evaluation of weekly paclitaxel hypersensitivity reactions reported utilizing an electronic medical record system at a tertiary cancer center.
abstract: OBJECTIVE
  This is a retrospective observational study evaluating hypersensitivity reactions captured by an electronic medical record (EMR) system for weekly paclitaxel infusions.
  
  
  METHODS
  The study evaluates the demographics, co-morbidities, premedications, chemotherapy agents, and postmedications of patients reporting a hypersensitivity reaction to weekly infusions of paclitaxel at a major cancer center, from June 2006 to December 2007. Data were analyzed using descriptive statistics and logistic regression. P values <0.05 were considered significant.
  
  
  RESULTS
  There were 51 hypersensitivity reactions in 36 patients during this time period that were documented in the allergy section of the EMR. Reactions occurred in patients with an average age of 55 years (SD = 10.77); 47 (92%) of the reactions occurred in females, and 42 (82%) of the reactions occurred with orders on the breast medical/surgical service. Thirty-two (63%) reactions occurred with either the first or second dose of weekly paclitaxel infusion. The most common premedication was dexamethasone (50 infusions), followed by diphenhydramine (18 infusions), and cimetidine (14 infusions). Thirty-three (65%) infusions had only one premedication. Postreaction, 41 (80%) cases had diphenhydramine and 30 (59%) cases had hydrocortisone administered prior to restarting the infusion. Logistic regression analysis did not indicate any relationship between history of previous allergies, hypertension, coronary disease, or chronic obstructive pulmonary disease and the number of premedications.
  
  
  CONCLUSIONS
  The results indicate that there is substantial variability in the type and number of premedications utilized in the management of paclitaxel hypersensitivity reactions. Interventions are needed to decrease the rate of hypersensitivity reactions from weekly paclitaxel infusions.
authors.affiliation: Division of Pharmacy, Drug Use Policy and Pharmacoeconomics, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. llal@mdanderson.org
authors.forename: Lincy S
authors.initials: LS
authors.lastname: Lal
authors.forename: Donna L
authors.initials: DL
authors.lastname: Gerber
authors.forename: Jason
authors.initials: J
authors.lastname: Lau
authors.forename: William
authors.initials: W
authors.lastname: Dana
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects*; D004334:Drug Administration Schedule; D004342:Drug Hypersensitivity / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects; D016015:Logistic Models; D016347:Medical Records Systems, Computerized; D017239:Paclitaxel / Q000009:adverse effects*; D011292:Premedication / Q000009:adverse effects*; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; D017239:Paclitaxel