- 作者：Ozge Uysal Soyer ; Selin Aytac ; Ayfer Tuncer ; Mualla Cetin ; Sevgi Yetgin ; Bulent Enis Sekerel
- 关键词：Acute lymphoblastic leukemia ; L-asparaginase ; child ; allergy ; premedication ; desensitization
- 刊名：Journal of Allergy and Clinical Immunology
- 出版年：2009
- 出版时间：April 2009
- 年：2009
- 卷：123
- 期：4
- 页码：895-899
- 全文大小：219 K
Background
L-asparaginase is a crucial chemotherapeutic agent for the treatment of acute lymphoblastic leukemia. The alternatives to L-asparaginase are not available in many parts of the world, including Turkey.Objective
We sought to evaluate the utility of premedication with or without a desensitization protocol in children with acute lymphoblastic leukemia and systemic hypersensitivity reactions to Escherichia coli–asparaginase.
Methods
In this prospective study patients with systemic hypersensitivity reactions to E coli–asparaginase for whom we were unable to ascertain/provide other alternatives to asparaginase were either premedicated, desensitized, or both to receive their chemotherapy as E coli–asparaginase according to the severity of the hypersensitivity reaction.
Results
Nineteen patients (13 male patients) with a mean age of 7.4 ± 4.7 years experienced a systemic hypersensitivity reaction to E coli–asparaginase during a 4-year period. Polyethylene glycol–asparaginase could be used for 3 patients. Eight of the remaining 16 children, who had experienced anaphylaxis, were premedicated and desensitized with E coli–asparaginase, and in 7 patients treatment was tolerated. The other 8 patients, with acute allergic reactions to E coli–asparaginase, were premedicated first, and 5 of them showed no reaction subsequently. Three of them demonstrated systemic hypersensitivity reactions again (anaphylaxis, n = 3), and premedication and desensitization with E coli–asparaginase resulted in anaphylaxis. Polyethylene glycol–asparaginase was administered uneventfully to the patients who could be provided it.
Conclusion
E coli–asparaginase could be administered to more than half of the patients who had a hypersensitivity reaction, and all of these patients were able to receive their planned doses of asparaginase. In countries with shortages of alternative asparaginase preparations, our approach might be a suitable option.