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Antineoplastics/mesna

Immediate hypersensitivity in paediatric patients: 9 case reports Five girls and four boys, aged 2-14 years, developed immediate hypersensitivity reactions during chemotherapy [see table]. The patients were undergoing treatment for systemic lupus erythematosus (patients 1 and 2), glioma (3–5), acute lymphoblastic leukaemia (6, 8, 9) or pure red cell aplasia (7). All patients developed immediate hypersensitivity reactions, presenting as urticaria in four patients and as anaphylaxis in five.

Patient characteristics Pt/sex/ age (y)

Suspect druga

Time to onset

1/F/7

monthly mesna infusion

2/F/7

monthly cyclophosphamide infusion weekly carboplatin infusion weekly IV carboplatin infusion weekly vincristine

10 min after initiation (cycle 5) 10 min after initiation (cycle 5)

3/M/14 4/F/12 5/M/12 and 6/F/8 7/F/2 8/M/7 and 9/M/5

ciclosporin IM asparaginase 800U tiw at wk 2 and 3 (phase 1); asparaginase (phase 4)b

5 min after initiation (cycle 6) 30 min after completion (cycle 2) during cycle 2 10 min after second course 10 min after administration (phase 4)c

dosages and routes not specified unless otherwise stated. 4-phase therapy (induction, maintenance, prophylaxis, intensification); asparaginase was administered in phases 1 and 4. c cycle 3 (pt 8), cycle 5 (pt 9). a

b

The implicated drugs were withdrawn in all patients. Four patients (1–3 and 7) underwent skin prick and intradermal tests with suspect drugs. Patient 1 had a positive reaction to the intradermal test with mesna, and the drug was omitted from her subsequent therapy cycles. Patient 2, who had been receiving the same chemotherapy regimen as patient 1, was successfully treated with chlorphenamine and then gradually rechallenged with cyclophosphamide. Patients 3 and 7 were also successfully rechallenged. In patients 4, 8 and 9, therapy was switched to a different drug. Patients 5 and 6 underwent successful desensitisation and continued therapy unchanged. Hypersensitivity reactions did not recur. Visitsunthorn N, et al. Immediate type hypersensitivity to chemotherapeutic agents in pediatric patients. Asian Pacific Journal of Allergy and Immunology 27: 803028581 191-197, No. 4, Dec 2009 - Thailand

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Reactions 14 Aug 2010 No. 1314