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Hypersensitivity or anaphylactic reactions during chemotherapy
Key facts:
• Can occur with giving the initial dose of a drug or during subsequent infusion of it
• Can occur at the beginning, middle, or end of the infusion
• Hypersensitivity risk varies according to drug given.
Hypersensitivity risk
High risk
Moderate to low risk Very low risk
• Asparaginase
• Paclitaxel
• Rituximab
•
•
•
•
•
•
•
•
•
•
Anthracyclines
Bleomycin
Carboplatin
Cisplatin
Cyclosporine
Etoposide
Melphalan
Methotrexate
Procarbazine
Teniposide
•
•
•
•
•
•
•
Chlorambucil
Cyclophosphamide
Cytarabine
Dacarbazine
Fluorouracil
Ifosfamide
Mitoxantrone
What to look for:
• Specific signs and symptoms vary with the severity of the reaction.
• Severe hypersensitivity and anaphylactic reactions are considered emergencies
and require immediate treatment.
Signs and symptoms of immediate hypersensitivity reaction
An immediate hypersensitivity reaction to a chemotherapeutic drug will appear within 5 minutes after starting
the drug.
Organ system
Subjective complaints
Objective findings
Respiratory
Dyspnea, inability to speak,
tightness in chest
Stridor, bronchospasm, decreased air
movement
Integumentary
Pruritus, urticaria
Cyanosis, urticaria, angioedema, cold
and clammy skin
Cardiovascular
Chest pain, increased heart
rate
Tachycardia, hypotension, arrhythmias
Central nervous system
Dizziness, agitation, anxiety
Decreased sensorium, loss of consciousness
What to do:
Treatment depends on the severity of the reaction and usually involves these steps:
• Stop the infusion.
• Begin a rapid infusion of normal saline solution to
Memory jogger
quickly dilute the drug.
When your patient has
• Check the patient’s vital signs.
an immediate hypersen• Notify the health care provider.
sitivity reaction, let
• Administer emergency drugs as ordered:
these three pairs of
—Antihistamines are typically given first, followed by corticosteroids and bronchodilators.
—Epinephrine is given first in severe anaphylactic reactions.
•
•
•
•
After you’ve administered the drug, monitor the patient’s vital signs and pulse oximetry every 5 minutes
until he’s stable, and then every 15 minutes for 1 to 2
hours—or follow your facility’s policies and procedures for treatment of acute allergic reactions.
Throughout the episode, maintain the patient’s airway, oxygenation, and tissue perfusion.
Make sure life-support equipment is available in case
the patient fails to respond.
Reassure the patient and his family; such reactions
can be very frightening.
words guide your response:
◊ Stop & stay (stop the
infusion and stay with
the patient).
◊ Check & call (check
vital signs and call the
health care provider).
◊ Open & ordered (open
the I.V. line containing normal saline solution and administer
ordered medication).
How to prevent it:
• If hypersensitivity is known, may premedicate patient with an antihistamine and a
corticosteroid.
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Excerpted from I.V. Therapy: An Incredibly Easy! Pocket Guide, Lippincott, Williams & Wilkins, 2006.
“Take 5” © Lippincott Williams & Wilkins, 2006.