Patients who receive chemotherapy infusions may experience anaphylactic reactions. A patient’s immune system identifies a chemotherapeutic agent as a “foreign invader” and marshals its resources to fight it.
Patients may experience symptoms of an anaphylactic reaction (e.g., rapid pulse, low blood pressure, difficulty breathing, swelling) immediately or within a few hours of medication administration.
Knowing how to treat a reaction is imperative. But there are also things that you—as a healthcare professional—can do to minimize the risk of anaphylactic reaction when treating patients receiving chemotherapy.
Know the Patient’s History. Has your patient experienced an allergic or anaphylactic reaction before? If so, she may be more susceptible to chemotherapy-induced anaphylaxis.
Know What Medications are Associated with Chemotherapy-Induced Anaphylaxis. Certain chemotherapeutic agents are known to carry risk for anaphylactic reactions,1 including:
- Aspariginase
- Cabazitaxel
- Carboplatin
- Cetuximab
- Cisplatin
- Etoposide
- Methotrexate
- Paclitaxel
- Rituximab
Note: This is a partial list of chemotherapy agents that may induce an anaphylactic reaction and is not intended to be complete. If you are unsure about a particular agent’s propensity for initiating an anaphylactic reaction, check the product label.
Follow the Appropriate Premedication Protocol. Many chemotherapy medications are given only after the patient has received a course of pre-medications. For example, patients receiving cetuximab should be premedicated with an H1 antagonist.1
What if Anaphylaxis Occurs?
Anaphylaxis is rare, but it does occur. Like an airplane pilot who hopes he or she never needs to execute an emergency landing, you hope you never need to use your skills to treat an anaphylactic reaction. However, like the airplane pilot, you must keep your knowledge and skills fresh, just in case.
Know the Difference Between a Side Effect, an Allergy, and an Anaphylactic Reaction. According to an article published in Australian Family Physician, “[d]rug allergy has immunological mechanisms: it may be severe, tends to be reproducible and may cross-react with structurally related drugs. Drug side-effects are more common and predictable, vary in severity and depend on the drug’s pharmacological action” (emphasis added).2 Anaphylaxis is an allergy that is severe and potentially life-threatening.
Know the Clinical Guidelines for Treating Anaphylaxis. The World Allergy Organization published the World Allergy Organization Clinical Guidelines for the Assessment and Management of Anaphylaxis because the organization recognized that without such guidelines, many cases of anaphylaxis would continue to be underreported and therefore undertreated.3
Provide Immediate Treatment. Follow your ordering physician’s protocol for treating an anaphylactic reaction. If none exists, obtain one prior to the administration of the chemotherapeutic agent or medication and be prepared to administer the treatment protocol published in the World Allergy Organization’s Guidelines.3 The Guidelines and many other subsequent publications confirm that epinephrine is first-line treatment for anaphylaxis.
Adjust the Protocol. Depending on the medication, the patient may need to be skin-tested to see if the medication elicits a reaction a second time. (Some chemotherapeutic agents, such as taxanes, don’t seem to respond to skin testing.4) Treatment with that agent may need to be continued unaltered with increased monitoring for anaphylactic reactions, with dosage adjustment, or discontinued altogether. Another alternative is to desensitize the patient to the agent.
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Sources
1 Product labels.
2 https://www.ncbi.nlm.nih.gov/pubmed/23529453
3 https://www.worldallergy.org/disease-focus/anaphylaxis#Guidelines
4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4117628/