Evaluation of hypersensitivity reactions to cancer chemotherapeutic agents in pediatric patients |
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| Institution: | 1. Division of Pediatric Allergy and Immunology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey;2. Division of Pediatric Hematology and Oncology, University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital, Ankara, Turkey;1. Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois;2. Departments of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC;1. Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, Stockholm, Sweden;2. Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden;3. Mastocytosis Center Karolinska, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden;4. Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany;1. Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland;2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;3. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;1. Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon;2. Clinical Research Institute, American University of Beirut, Beirut, Lebanon;1. Brigham & Women''s Hospital, Department of Medicine, Division of Allergy and Clinical Immunology, Boston, Mass;2. Allergy & Severe Asthma Service, St Bartholomew''s Hospital, Barts Health NHS Trust, London, United Kingdom;3. Massachusetts General Hospital, Department of Medicine, Division of Rheumatology, Allergy, and Immunology, Boston, Mass;4. Division of Allergy, Ramon y Cajal University Hospital, Madrid, Spain |
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| Abstract: | BackgroundHypersensitivity reactions (HSRs) to chemotherapeutic agents have been increasingly documented.ObjectiveThe aim of this study was to investigate HSRs due to chemotherapeutics agents in childhood.MethodsFrom January 2007 to June 2019, the patients who were treated for neoplastic diseases in our hospital were evaluated. Patients who developed a HSR to a chemotherapeutic agent were included.ResultsFifty-seven patients with 65 reactions (60% anaphylaxis) were evaluated. Escherichia coli asparaginase was responsible for 38 (58.5%) of these 65 reactions. The other agents were polyethylene glycol (PEG)–asparaginase (n = 11), etoposide (n = 7), methotrexate (n = 4), carboplatin (n = 4), and procarbazine (n = 1). Of the 38 patients who had a reaction to E coli–asparaginase, 33 patients received alternative treatment (PEG-asparaginase or Erwinia asparaginase), 3 patients continued with desensitization, and 2 patients underwent bone marrow transplantation. Five patients who had an initial reaction to PEG-asparaginase continued their treatment with Erwinia asparaginase or E coli asparaginase uneventfully. Of 7 patients who had a reaction to etoposide (4 had anaphylaxis), 3 patients continued with desensitization, and 2 patients used the drug with premedication and prolonged infusion. Two patients had anaphylaxis with methotrexate. Treatment was continued with desensitization in 1 patient and methotrexate treatment was discontinued in the other patient. Of the 4 patients with carboplatin hypersensitivity, 2 had anaphylaxis. Desensitization was performed in 2 patients. One patient had procarbazine HSR, drug was given with premedication.ConclusionAmong all chemotherapeutic agents reviewed in our study that caused HSRs, asparaginase was the most common culprit agent in children. Most of reactions are immediate type. Many of the patients can take their treatment by drug replacement or desensitization. |
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