CHILDHOOD ANAPHYLAXIS: NEW DEVELOPMENTS IN DIAGNOSIS AND TREATMENT

CHILDHOOD_ANAPHYLAXIS_NEW_DEVELOPMENTS _IN_DIAGNOSIS_AND_TREATMENT_kapak

ANAPHYLAXIS WITH CHEMOTHERAPEUTICS

Yahya Gül

Diyarbakır Children’s Diseases Hospital, Department of Pediatric Immunology and Allergic Diseases, Diyarbakır, Türkiye

Gül Y. Anaphylaxis with Chemotherapeutics. In: Harmancı K, editor. Childhood Anaphylaxis: New Developments in Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.157-165.

ABSTRACT

In addition to the well-known toxic side effects of chemotherapeutic drugs, infusion reactions—defined as unexpected responses-may also occur. The cytotoxic agents most commonly associated with infusion reactions include platinum compounds, taxanes, asparaginase, epipodophyllotoxins, cytarabine, cyclophosphamide, ixabepilone, and liposomal doxorubicin. Although these reactions are often termed “hypersensitivity reactions,” many lack a confirmed immunological mechanism. Hypersensitivity reactions induced by chemotherapeutic agents can lead to anaphylaxis and even death. Platinum hypersensitivity reactions are frequently associated with IgE-mediated sensitization, occurring after repeated infusions, and all platinum drugs have been linked to anaphylaxis. Hypersensitivity reactions to taxanes are common, although the risk decreases with repeated exposure. The precise mechanism underlying taxane hypersensitivity reactions remains unclear; however, the timing of these reactions suggests mediation via the direct release of mast cell mediators, such as histamine and tryptase, in the absence of IgE sensitization. Hypersensitivity reactions to asparaginase range from localized, transient erythema and rash at the injection site to severe reactions culminating in life-threatening anaphylaxis, with the underlying mechanism not yet fully elucidated. In the case of epipodophyllotoxins-such as etoposide and teniposide-both immunological and non-immunological mechanisms may provoke reactions, sometimes resulting in severe outcomes like hypotension and anaphylaxis. Hypersensitivity reactions to chemotherapeutic agents represent unpredictable adverse effects with potentially fatal consequences. Thus, the accurate diagnosis and appropriate management of oncologic patients who develop anaphylaxis are critical for both effective disease treatment and the safe administration of these medications.

Keywords: Anaphylaxis; Chemotherapy; Drugs; Hypersensitivity reactions

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