title: Anaphylactic reaction to polyethylene-glycol conjugated-asparaginase: premedication and desensitization may not be sufficient.
abstract: In hypersensitive reactions to native L-asparaginase, either premedication and desensitization or substitution with polyethylene glycol conjugated asparaginase (PEG-ASP) is preferred. Anaphylaxis with PEG-ASP is rare. An 8-year-old girl and a 2.5-year-old boy, both diagnosed as having acute lymphoblastic leukemia, presented with native L-asparaginase hypersensitivity and substitution with PEG-ASP was preferred. They received a premedication (methylprednisolone, hydroxyzine and ranitidine) followed by desensitization with PEG-ASP infusion. Both patients developed anaphylaxis with peg-asparaginase. These are the first reported cases of anaphylactic reaction to PEG-ASP, despite the application of both premedication and desensitization. Anaphylaxis with PEG-ASP is very rare and premedication and desensitization protocols may not prevent these hypersensitive reactions.
authors.affiliation: Department of Pediatric Allergy and Asthma, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Umit M
authors.initials: UM
authors.lastname: Sahiner
authors.forename: S Tolga
authors.initials: ST
authors.lastname: Yavuz
authors.forename: Muge
authors.initials: M
authors.lastname: Gökce
authors.forename: Betul
authors.initials: B
authors.lastname: Buyuktiryaki
authors.forename: Ilhan
authors.initials: I
authors.lastname: Altan
authors.forename: Selin
authors.initials: S
authors.lastname: Aytac
authors.forename: Murat
authors.initials: M
authors.lastname: Tuncer
authors.forename: Ayfer
authors.initials: A
authors.lastname: Tuncer
authors.forename: Cansin
authors.initials: C
authors.lastname: Sackesen
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced* / Q000517:prevention & control; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001215:Asparaginase / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003692:Delayed-Action Preparations; D003888:Desensitization, Immunologic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011092:Polyethylene Glycols / Q000009:adverse effects* / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D011292:Premedication / Q000379:methods*
chemical_list: D000970:Antineoplastic Agents; D003692:Delayed-Action Preparations; D011092:Polyethylene Glycols; C042705:pegaspargase; D001215:Asparaginase
keywords: anaphylaxis; desensitization; hypersensitivity; polyethylene-glycol asparaginase; premedication