Home

Loading...

Table of contents

Hypersensitivity reactions to chemotherapy

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of hypersensitivity reactions to chemotherapy are prepared by our editorial team based on guidelines from the American Academy of Allergy, Asthma & Immunology (AAAAI 2022), the European Academy of Allergy and Clinical Immunology (EAACI 2022), the European Society of Medical Oncology (ESMO 2017), the Comité de l'évolution de la pratique en ...
Show more

Screening and diagnosis

Pathogenesis: as per EAACI 2022 guidelines, recognize the pathogenetic mechanisms of hypersensitivity reactions to different chemotherapeutic agents:
Situation
Guidance
Platinum compounds
IgE-mediated reactions in some immediate, often severe cases
B
Taxanes
Direct activation of complement system by the drug in the majority of cases
IgE-mediated reactions in some cases
B
Epipodophyllotoxins
Immunologic and non-immunologic mechanisms
B
Create free account

Classification and risk stratification

Risk factors: as per ESMO 2017 guidelines, take into account other risk factors apart from being aware of the potential risk of an infusion reaction of a specific drug, when delivering anticancer drugs, and during which course it is most likely to happen.
B
Show 2 more

More topics in this section

  • Severity grading

Diagnostic investigations

Skin testing: as per EAACI 2022 guidelines, recognize that skin testing is the most readily available diagnostic test.
B
Show 3 more

More topics in this section

  • Drug provocation test

  • In vitro IgE testing

  • Tryptase and histamine tests

Medical management

Observation
As per ESMO 2017 guidelines:
Recognize that prompt recognition and immediate medical attention are essential.
Recognize that some patients feel odd or uncomfortable or express a need to urinate or defecate before an infusion reaction. Pay serious attention to those symptoms and evaluate the patient by measuring BP and pulse rate.
B

More topics in this section

  • Initial supportive therapy

  • Management of anaphylaxis

  • Drug desensitization

Nonpharmacologic interventions

Psychological support
As per ESMO 2017 guidelines:
Provide psychological intervention to alleviate symptoms of uncertainty related to a potential infusion reaction with anticancer drugs.
B
Provide psychological support and have a complete, informative discussion with the patient about the potential benefits of continuing with the drug and the risk of infusion reaction recurrence.
B

Specific circumstances

Patients with chemotherapy extravasation: as per EONS/ESMO 2012 guidelines, initiate general unspecific measures immediately upon diagnosis of chemotherapy extravasation.
B
Show 7 more

Preventative measures

Preparation before drug delivery: as per ESMO 2017 guidelines, elicit a medical history, ask about previous allergic disorders, atopic status and concomitant treatments before the administration of any drug.
B
Show 2 more

More topics in this section

  • Premedication

  • Rate of administration

  • Prevention of future episodes

Follow-up and surveillance

Post-reaction monitoring: as per ESMO 2017 guidelines, obtain close observation for 24 hours after a severe reaction. Monitor vital signs and control recurrence symptoms.
B
Show 3 more

More topics in this section

  • Rechallenge

Quality improvement

Reporting: as per ESMO 2017 guidelines, ensure accurate documentation of the infusion reaction episode, including pre-infusion assessments, an appropriate description and grading of the infusion reaction (according to accepted classifications such as CTCAE), and how it was managed.
B