Immediate type hypersensitivity to chemotherapeutic agents in pediatric patients.
Nine patients (3 boys and 6 girls) with a median age of 9.5 years, with immediate type hypersensitivity reactions to chemotherapeutic agents were reviewed. The presenting symptoms were urticaria (4/9) and anaphylaxis (5/9). The causative agents were vincristine (2/9), L-asparaginase (2/9), mesna (1/9), cyclosporine (1/9), carboplatin (2/9) and cyclophosphamide (1/9). Three of the five patients with anaphylaxis were changed to alternative chemotherapeutic agents. In two cases alternative drugs were not available and the patients underwent safe and successful desensitization. Three of the 4 patients with urticaria were successfully exposed to graded challenges with cyclosporine, carboplatin and cyclophosphamide, respectively. In the other case with generalized urticaria, mesna was withdrawn due to a positive intradermal test. In patients with immediate type hypersensitivity reactions to chemotherapeutic drugs, if effective alternative chemotherapeutic agents are not available and/or the skin test is negative, a careful drug challenge and/or desensitization should be performed.
Visitsunthorn
Nualanong
N
Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand. sinvs@mahidol.ac.th
Utsawapreechawong
Wipa
W
Pacharn
Punchama
P
Jirapongsananuruk
Orathai
O
Vichyanond
Pakit
P
D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D016543:Central Nervous System Neoplasms / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D003888:Desensitization, Immunologic; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005910:Glioma / Q000188:drug therapy; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D015080:Mesna / Q000008:administration & dosage / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D012882:Skin Tests; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D028761:Withholding Treatment
D000970:Antineoplastic Agents; D014750:Vincristine; D016190:Carboplatin; D001215:Asparaginase; D015080:Mesna