L-asparaginaz allerjisi sürekli adrenalin infüzyonu eşliğinde yapılan desensitizasyonla aşılabilir mi?
Kemoterapötik ilaç allerjileri klinik pratikte önemli bir problemdir. Çünkü bu antineoplastik ilaçlar bir protokol çerçevesinde kullanılması zorunlu ilaçlardır. L-asparaginaz hipersensitivite reaksiyonlarının sık yaşandığı antineoplastik ilaçlardan birisidir. L-asparaginaz ile hipersensitivite reaksiyonları %5-35 ve hayatı tehdit eden anaflaktik reaksiyonlar %10 olguda bildirilmektedir. L- asparaginaz kullanımı zorunlu ve hipersensitivite reaksiyonu gelişen vakalarda parenteral desensitizasyon önerilen önemli alternatif yollardan birisidir. Biz burada L-asparaginaz kullanımı esnasında anaflaksi gelişen üç akut lenfoblastik lösemili olguda intravenöz adrenalin infüzyonu ile desensitizasyonu başarılı bir şekilde uyguladık.
May L-asparaginase allergies be removed by desensitization with continous adrenaline infusion?
The allergic reactions related to chemotherapeutic drugs represent a very significiant problem in clinical practice as all these antineoplastic drugs must be used in a phase associated schedule. L-asparaginase is an antineoplastic drug in which hypersensitivity reactions can be seen commonly. It is estimated that hypersensitivity reactions may occur in 5-35% and life threatening anaphylactic reactions occur 10% of the cases. Parenteral desensitization is an alternative procedure in cases who develop hypersensitivity reactions with L-asparaginase. In this paper, we present three cases with acute lymphoblastic leukemia who developed anaphylactic reaction related to L-asparaginase and was desensitizated with intravenous adrenaline infusion succesfully.
___
- 1. Gonzáles ID, Saez RS, Rodilla EM, Yges y EL, Toledano FL. Hypersensitivity reactions to chemotherapy drugs. Alergol Immunol Clin 2000;15: 161-81.
- 1. Capizzi RL, Bertino JR, Skeel RT, Creasey WA, Zanes R, Olayon C, et al. L-asparaginase:Clinical, biochemical, pharmacological and immunological studies. Ann Intern Med 1971;74: 893-901.
- 2. Graham ML. Pegaspargase: a review of clinical studies. Adv Drug Deliv Rev 2003;55: 1293-302.
- 3. Müler HJ, Beier R, Löning L, Blütters-Sawatzki R, Dörfeel W, Maase E, et al. Pharmacokinetics of native Escherichia coli asparaginase (Asparaginase medac) and hypersensitivity reactions in ALL-BFM 95 reinduction treatment. Br J Haematol 2001;114: 794-9.
- 4. Scwinger W, Urban C, Lackner H. Clinical experiences with adrenaline as therapy and prevention of E. Coli-L-asparaginase-induced anaphylaxis. Klin Pediatr 1992;204: 274-6.
- 5. Bonno M, Kawasaki H, Hori H, Umemoto M, Komada Y, Sakurai M. Rapid desensitization for L-asparaginase hypersensitivity. J Allergy Clin Immunol 1998;101: 571-2.
- 6. Goldberg A, Confino-Cohen R, Fishman A, Beyth Y, Altaras M. A modified, prolonged desensitization protocol in carboplatin allergy. J Allergy Clin Immunol 1996;98: 841-3.
- 7. Soyer OU, Aytac S, Tuncer A, Cetin M, Yetgin S, Sekerel BE. Alternative algorithm for L-asparaginase allergy in children with acute lymphoblastic leukemia. J Allergy Clin Immunol 2009;123: 895-9. Epub 2008 Dec 10.