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oa Current Allergy & Clinical Immunology - Reaction to chemotherapy : a focus on asparaginase : guest review

Volume 29 Number 4
  • ISSN : 1609-3607

 

Abstract

Severe allergic reactions occur to L-asparaginase, an important chemotherapeutic agent in treatment of childhood leukaemia. Newer formulations of asparaginase associated with less adverse reactions are not readily affordable or accessible in many resource-poor countries.


Two children with prior severe allergic reactions (anaphylaxis) to L-asparginase were pre-medicated with H1 and H2 antihistamines, and received L-asparaginase administered using a four-dose, 13-step desensitisation protocol. The protocols were commenced in individual patients with each step lasting 30 minutes for a total duration of six-and-a-half hours, but with subsequent successful infusions on a single subject, subjects were tried on sequentially faster protocols by increasing the infusion rates of steps to reach a lower duration of time and/or omitting the first three to six steps of this protocol. This was particularly successful in children on the lower dose (6 000 U/m2) infusions and for those with short delays between subsequent infusions. Where subjects received 3 × 6 000 U/m2 doses in one week, these were done preferably on subsequent days to allow immunological memory to persist and allow more rapid infusion protocols. We performed 37 desensitisation procedures on the two index patients over a seven-month period. One subject had no adverse reactions, the other had five adverse reactions comprising non-allergic side-effects (three), one minor reaction (urticaria) and one major reaction (urticaria, stridor and behaviour change) requiring a single dose of IM adrenaline. The major reaction occurred when the higher dose of asparaginase (15 000/m2) was given via a shorter duration of administration after a two-week intervening period since the last prior infusion. With premedication and desensitisation, L-asparaginase can be successfully administered to children with prior severe allergic reactions.

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/content/caci/29/4/EJC200133
2016-12-01
2019-12-08

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