title: Incidence, clinical features and management of hypersensitivity reactions to chemotherapeutic drugs in children with cancer.
abstract: OBJECTIVE
  Hypersensitivity reactions (HSRs) may occur in children with cancer during the use of almost all chemotherapeutic drugs. HSRs may also produce a negative impact on treatment intensity and, as a consequence, worsen patients' outcome. The aim of this review is to summarize the incidence and the clinical features of HSRs occurring in children with cancer treated with chemotherapeutic drugs and their impact on treatment efficacy, in order to outline possible adequate prevention and management strategies.
  
  
  METHODS
  Data were collected by searching for relevant studies about incidence, clinical features and management of hypersensitivity reactions that may occur with the use of chemotherapeutic agents in children aged 0-18 years, published from January 1976 to December 2012 in the PubMed database.
  
  
  RESULTS
  In children with cancer treated with chemotherapeutic drugs (especially platinum compounds, methotrexate, L-asparaginase), HSRs commonly present with mild/moderate to severe clinical patterns. Multiple factors appear to affect reaction rates, including route, rate of administration, previous exposure, drug form, presence of excipients. The occurrence of hypersensitivity to a chemotherapeutic agent can include the avoidance of re-exposure. For sensitized patients who have derived clinically meaningful benefit from a particular agent, however, continuation of treatment with the agent is desirable. Options may include attempting a trial of desensitization or treatment with a related compound.
  
  
  CONCLUSIONS
  With the increasing use of cancer chemotherapy agents, hypersensitivity reactions to antineoplastic drugs are commonly encountered. Clinicians must not underestimate the potential risk and occurrence of HSRs in the pediatric population. Knowledge of the different presentations of these reactions can help to develop strategies for the prevention and the management of HSRs in order to ensure treatment outcome, to improve the quality of patient care and to reduce healthcare costs.
authors.affiliation: Division of Pediatric Oncology, Catholic University of Rome, Rome, Italy, ruggiero@rm.unicatt.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ruggiero
authors.forename: Silvia
authors.initials: S
authors.lastname: Triarico
authors.forename: Giovanna
authors.initials: G
authors.lastname: Trombatore
authors.forename: Andrea
authors.initials: A
authors.lastname: Battista
authors.forename: Fabiola
authors.initials: F
authors.lastname: Dell'acqua
authors.forename: Carmelo
authors.initials: C
authors.lastname: Rizzari
authors.forename: Riccardo
authors.initials: R
authors.lastname: Riccardi
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D003888:Desensitization, Immunologic; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D009369:Neoplasms / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents