A desensitization protocol in children with L-asparaginase hypersensitivity.
BACKGROUND
L-asparaginase is effective in the treatment of malignant diseases, but it has been associated with hypersensitivity reactions in 5% to 45% of the patients.


OBJECTIVE
To determine whether a desensitization protocol in children with native Escherichia coli L-asparaginase hypersensitivity allows subsequent safe administration of native E. coli L-asparaginase.


METHODS
A desensitization protocol was used in 9 children with leukemia (n=8) or Langerhans cell histiocytosis (n=1) and previous severe (n=4) or mild/moderate (n=5) L-asparaginase hypersensitivity. Dexamethasone (2 mg/kg intravenously) and pheniramine hydrogen maleate (1 mg/kg intravenously) were administered 1 hour before each of the following L-asparaginase administrations. Subsequently, 0.1%, 1%, 5%, 10%, and the remaining 84% of the total dose of L-asparaginase (10,000 IU/m2) were each prepared in 240 mL 0.9% saline and infused over 4 hours (20 h in total).


RESULTS
After desensitization, none of the patients had recurrence of hypersensitivity reactions during the subsequent 2 to 15 doses (median: 6 doses/patient; 68 doses in total) of native E. coli L-asparaginase.


CONCLUSIONS
This desensitization protocol was safe and allows continued administration of native E. coli L-asparaginase administration.
Akbayram
Sinan
S
Department of Pediatric Hematology, Yüzüncü Yil University Faculty of Medicines, Van, Turkey. drsinanakbayram@gmail.com
Doğan
Murat
M
Akgün
Cihangir
C
Caksen
Hüseyin
H
Oner
Ahmet Faik
AF
D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001215:Asparaginase / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003888:Desensitization, Immunologic; D004342:Drug Hypersensitivity / Q000209:etiology*; D004926:Escherichia coli / Q000201:enzymology; D005260:Female; D006646:Histiocytosis, Langerhans-Cell / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012074:Remission Induction; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D001215:Asparaginase