title: Anaphylaxis during the first course of high-dose methotrexate: a case report and literature review.
abstract: OBJECTIVE
  Methotrexate (MTX) is widely used in the management of paediatric cancer with a generally favourable benefit/risk profile. We report an unusual adverse drug reaction with the first course of high-dose MTX in a paediatric patient and review the literature for similar cases.
  
  
  METHODS
  An 11-year-old boy with small-cell osteoblastic osteosarcoma in the lower limb experienced a case of life-threatening anaphylaxis during the first course of high-dose MTX. The adverse event occurred during the first course, likely due to an immune-mediated mechanism. We postulate that prior antineoplastic treatment might have contributed to the immune response to MTX.
  
  
  CONCLUSIONS
  Given that this reaction has rarely been reported, we discuss the present case with a review of other similar cases. Further studies are needed to substantiate this 'signal alarm' for serious MTX-related hypersensitivity reactions.
authors.affiliation: Tuscan Regional Centre of Pharmacovigilance, Florence, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pugi
authors.forename: S
authors.initials: S
authors.lastname: Benemei
authors.forename: M
authors.initials: M
authors.lastname: Vietri
authors.forename: A
authors.initials: A
authors.lastname: Tondo
authors.forename: A M
authors.initials: AM
authors.lastname: Calvani
authors.forename: A
authors.initials: A
authors.lastname: Mugelli
authors.forename: A
authors.initials: A
authors.lastname: Vannacci
authors.forename: F
authors.initials: F
authors.lastname: Lapi
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced* / Q000276:immunology; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000473:pathology; D002648:Child; D004305:Dose-Response Relationship, Drug; D004342:Drug Hypersensitivity / Q000209:etiology / Q000276:immunology; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D012516:Osteosarcoma / Q000188:drug therapy / Q000473:pathology
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate