Management of hypersensitivity reactions
Seventeen respondents (33.3%) indicated that they routinely administer
pre-medications before all doses of pegaspargase, even if the patient
has not experienced an infusion-related reaction. These respondents were
from the Hospital for Sick Children, McMaster University, British
Columbia Children’s Hospital and the IWK Health Centre.
8 respondents (15.7%) indicated they have never administered
pre-medication before pegaspargase. Five respondents (9.8%) indicated
they would only administer pre-medications before pegaspargase if
checking asparaginase levels. When asked about which grades of infusion
reactions would prompt the routine administration of pre-medication, a
history of a Grade 1 infusion-related reaction was chosen as a response
13.9% of the time, Grade 2 reaction 23.1% of the time, and Grade 3 and
4 reactions both at 6.2% of the time (presumably because these patients
would have been switched to Erwinia asparaginase).
The most common premedication used was identified as antihistamine (H1
receptor antagonists) with a relative frequency of 60.8%, followed by
steroids (relative frequency=25.5%), H2 receptor antagonists (relative
frequency=23.5%), anti-emetics (relative frequency=19.6%) and
antipyretics (relative frequency=19.6%).
47% of respondents indicated they would “re-challenge” pegaspargase
in a patient with a previous history of an infusion-related reaction,
but only if the patient had a history of a Grade 1 or 2 infusion-related
reaction. 25.5% of respondents indicated they would only consider a
“re-challenge” if the initial reaction was Grade 1. 17.6% of
respondents indicated they would rechallenge even if the patient had a
history of a Grade 3 infusion-related reaction, while 7.8% of
respondents indicated they would never attempt to administer IV
pegasparagase again to that patient, regardless of the Grade of infusion
reaction.