= CHEMOTHERAPY REACTIONS = Joana Caiado MAIN TOPICS DIAGNOSIS. Clinical evaluation. In vivo evaluation. In vitro evaluation
|
|
- Clyde Crawford
- 5 years ago
- Views:
Transcription
1 1203 Course: Drug Hypersensitivity and Allergy: From Diagnosis To Treatment = CHEMOTHERAPY REACTIONS = Joana Caiado Immunoallergology Department Hospital Santa Maria Lisbon Portugal February 22 nd MAIN TOPICS Virtually all chemotherapeutic agents have the potential to initiate infusion reactions Oncologic patients have higher survival rates more re-exposure to the same chemotherapy agents due to recurrence of the disease Severe Hypersensitivity reactions (HSR) can lead to the suspension of first line treatments Allergic reactions Hypersensitivity reactions Standard infusion reactions DIAGNOSIS Clinical evaluation Description of the reaction Physical examination In vivo evaluation Skin testing In vitro evaluation Immediate analysis (serum tryptase, liver function, circulating immune complexe ) Further investigation (specific IgE) 1
2 CLINICAL EVALUATION Identification of the drug responsible for the reaction Other drugs infusing at the same time or immediately before To quantify previous infusions with the same drug with no HSR Allergic symptoms in previous infusions Drugs taken at home / over the counter Food ingestion before the infusion Evaluation of infectious symptoms CLINICAL EVALUATION Cutaneous symptoms: flushing, itching, urticaria, and/or angioedema (usually of face, eyelids, or lips) Respiratory symptoms: repetitive cough, sudden nasal congestion, shortness of breath, chest tightness, wheeze, sensation of throat closure or choking, and/or change in voice quality (due to laryngeal edema), hypoxia Cardiovascular symptoms: faintness, tachycardia (or less often bradycardia), hypotension, hypertension and/or loss of consciousness Gastrointestinal symptoms: nausea, vomiting, abdominal cramping, and/or diarrhea Neuromuscular symptoms: sense of impending doom, tunnel vision, dizziness, and/or seizure, severe back, chest, pelvic pain Castells MC, Matulonis UA. Infusion reactions to systemic chemotherapy. In UpToDate. Drews RE (Ed). Adkinson NF. Boston MA, 2012 PHYSICAL EXAM General appearance - State of consciousness - Temperature - Signs of respiratory distress / Oxygen saturation - Dysphonia - Chest tightness Arterial Pressure Lookout for hypotension Anaphylactic shock!!! Observation of the skin and mucosae - Oropharynx (Tongue/uvula edema) - Angioedema - Observation and characterization of skin lesions Pulmonary auscultation exclude wheezing 2
3 PHYSICAL EXAM CUTANEOUS LESIONS URTICARIA ANGIOEDEMA PHYSICAL EXAM MACULOPAPULAR RASH DRUG-INDUCED VIRAL PHYSICAL EXAM BLISTERING LESIONS ERYTHEMA MULTIFORME STEVENS-JOHNSON SYNDROME TOXIC EPIDERMAL NECROLYSIS 3
4 SERUM MEDIATORS Serum tryptase - In immediate reactions - Evaluates mast cell degranulation - Blood should be withdrawn from 20 minutes to 2 hours after the reaction Complement / Circulating immune complexes - For the diagnosis of type III reactions Exclusion of other potential causes - Reactive C protein - Viral serologies - Eosinophilia / liver function tests Total IgE and specificige to platins HYPERSENSITIVITY REACTIONS- CLASSIFICATION According to timing Immediate (< 1 hora) Acelerated (> 1 h; < 24h) Delayed (> 24h) According to Severity Adapted from: National Cancer Institute: Cancer Therapy Evaluation Program.Common terminology criteria for adverse events v3.0. Available from: PATIENT ASSESSMENT Castells M. Drug desensitization in Oncology: chemotherapy agents and monoclonal antibodies. In Pichler WJ (Ed). Drug hypersensitivity. 1st ed: Basel: Karger; 2007:
5 COLLABORATION WITH ONCOLOGY When a HSR occurs in Oncology Day Care Unit Call the Allergist Delayed reaction Immediate reaction Suspend and substitute the chemotherapy agent Pre-medication with antihistamine and/or corticosteroids Taxanes / others - Clinical evaluation - Risk assessment Platins/ Monoclonals - Clinical evaluation - Skin testing - Risk assessment No desensitization? Consider Desensitization MOST FREQUENT AGENTS INDUCING HSR PLATINUM SALTS (12-19%) - Cisplatin (5 to 20%) - Carboplatin (9% to 27%) - Oxaliplatin (12% to 25 %) TAXANES (5-45%) - Paclitaxel - Docetaxel 42 % incidence of infusion reactions in children receiving carboplatin for brain tumors PEGYLATED LIPOSOMAL DOXORUBYCIN PODOPHYLLOTOXINS - Etoposide and teniposide MONOCLONAL ANTIBODIES - Trastuzumab - Rituximab - Cetuximab Management and Preparedness for Infusion and Hypersensitivity Reactions. Oncologist 2007;12(5):601-9 IMMEDIATE REACTIONS ALLERGIC HYPERSENSITIVITY Immunologic mechanism identified NON-ALLERGIC HYPERSENSITIVITY Immunologic mechanism unknown Most frequently type I (IgE mediated) Hypothesis - Direct mast cell activation and degranulation? - Complement activation? Requires prior sensitization (usually more than 2 exposures) Reactions on the 1 st or 2 nd exposures Positive skin testing Skin testing persistently negative Diverse clinical presentation Clinical presentation similar to IgE- mediated reactions PLATINS TAXANES 5
6 PLATINUM SALTS Prevent cell division by inhibiting DNA replication good anti-tumor activity in several solid tumors RHS described in platinum refinery workers - identification of specific IgE to platinum salts Cleare MK, et al. Immediate (type I) allergic responses to platinum compounds. Clin Allergy.1976; 6: CISPLATIN: first to be used in the 70s Nephrotoxicity CARBOPLATIN: second-generation platinum salt - Better toxicity profile - Gynecologic malignancies OXALIPLATIN: third-generation platinum derivative - Metastatic colorectal cancer PLATINUM SALTS Classic type I IgE-mediated allergic reactions Require repeated exposures before the onset of the hypersensitivity Frequent presentation: Pruritus, urticaria, bronchospasm, facial swelling, and hypotension Severe anaphylaxis Less frequent presentation: type II reactions (immune-mediated hemolytic anemia or thrombocytopenia) type III reactions (delayed vasculitic urticaria) SKIN TESTING Crucial for the diagnosis of HSR to platins (good predictive value), and to some monoclonal antibodies Dilutions are prepared at the Pharmacy on the day of skin testing Performed by Allergists, two to four weeks after a HSR occurs, and to evaluate cutaneous sensitization even in the absence of a HSR Skin prick test Intradermal 6
7 SKIN TESTING 33x35mm 17x20mm SKIN TESTING Non irritant concentrations Prick Intradermal Carboplatin 10 mg/ml (1:1) 10* or 3 to 5 mg/ml Oxaliplatin 5 mg/ml (1:1) 3 to 5 mg/ml Cisplatin 1 mg/ml (1:1) 1 mg/ml Sensitization is far higher after 6 carboplatin infusions < 1% when less than 5 infusions % more than 6 infusions Leguy -Seguin V at al. Diagnostic and predictive value of skin testing in platinum salt hypersensitivity. J Allergy Clin Immunol 2007;119: Sliesoraitis S, Chikhale PJ. Carboplatin hypersensitivity. Int J Gynecol Cancer 2005, 15, Zanotti KM et al. Prevention and management of antineoplastic -induced hypersensitivity reactions. Drug Safety 2001;24(10): Castells M. Rapid desensitization for hypersensitivity reactions to chemotherapy agents. Curr Opin Allergy Clin Immunol 2006;6:271-7 SKIN TESTING High sensitivity of skin testing Castells et al 2008: 88% Hesterberg et al 2009: 36-83% (according to timing > or < 9 months after HSR) Very few false negative results (+/-1.5%) Patients needing more than 6 carboplatin infusions Maintain regular chemo infusions Suspend chemo/ Desensitization Negative Positive Skin testing after the 7 th infusion Skin testing reliably predicts the majority of anaphylactic reactions to platinum-type drugs Hesterberg AP et al. J Allergy Clin Immunol 2009;123: Leguy -Seguin V at al. Diagnostic and predictive value of skin testing in platinum salt hypersensitivity. J Allergy Clin Immunol 2007;119: Castells MC, et al. Hypersensitivity reactions to chemotherapy: outcomes and safety of rapid desensitization in 413 cases. J Allergy Clin Immunol 2008;122(3):
8 SPECIFIC IgE TO PLATINS EAACI patients from Lisbon and Boston (Crb=12; Ox=12) Female-9; Male-5 (Mean age -61) with immediate hypersensitivity reactions to carboplatin and oxaliplatin Skin testing with culprit drug in 22 patients: Crb=12 10 mg/ml Ox=10 5 mg/ml sige (UniCAP; Phadia - Sweden) was performed for both platins (cut-off of 0.10 ku A/l) 24 Patients 17 Controls (Crb=5; Ox=12) RESULTS: carboplatin sensitized patients Pts Gender/ Age Drug Reaction Skin tests (mg/ml) sige Crb (ku A/l) sige Ox (ku A/l) 1 F/ 65 Crb Anaphylactic shock Crb: 0.1 ID < 0,10 < 0,10 2 F/ 52 Crb Crb: 10 SPT < 0,10 < 0,10 3 F/ 56 Crb Nasal obstruction; generalized urticaria Crb: 1 ID 1,20 < 0,10 4 F/ 71 Crb Generalized rash;, dyspnea Crb: 0.1 ID < 0,10 < 0,10 5 F/ 45 Crb Anaphylactic shock Crb: 0.1 ID 0,14 < 0,10 6 F/ 62 Crb Anaphylaxis, flushing, vomiting, fainting Crb: 1 ID 8.9 < 0,10 7 F/ 71 Crb Swelling tongue, ithcy hands,vomiting, rash, dyspnea Crb: 1 ID 1.2 < 0,10 8 F/ 69 Crb Dyspnea,flushing, wheezing, desaturation Crb: 10 SPT < 0,10 < 0,10 9 F/ 65 Crb Syncope, hypotension, vomiting, red rash Crb: 10 SPT 0.18 < 0,10 10 F/54 Crb Itchy palms, redness Crb: 1 ID < 0,10 < 0,10 11 F/ 51 Crb Hypotension, red rash, chest tightness, vomiting, Crb: 10 SPT 0.85 < 0,10 12 F/ 65 Crb Nausea, abdominal pain, collapse, cardiorespiratory arest Crb: 1 ID 0.49 < 0,10 F- female; M- male; Crb. Carboplatin; SPT- skin prick test; ID: intradermal RESULTS: oxaliplatin sensitized patients Pts Gender/ Age Drug Reaction Skin tests (mg/ml) sige Crb (ku A/l) sige Ox (ku A/l) 1 M/ 54 Ox Generalized rash; facial fushing, dyspnea, Ox: 5 TCP 1,60 0,16 2 F/ 62 Ox Itchy palmar Erytema, dyspnea Ox: 0.5 ID 1,70 2,80 3 M/ 69 Ox Facial flushing and lip angioedema Ox: 0.5 ID 0,31 0,22 4 M/ 62 Ox 5 F/ 57 Ox Facial flushing, dyspnea, bronchospasm and chills Facial flushing, dyspnea, bronchospasm and generalized rash Ox: 0.5 ID 8,8 4,9 Ox: 0.5 ID <0,10 1,5 6 F/ 51 Ox Facial flushing e generalized urticaria Ox: 0.5 ID <0,10 <0,10 7 F/ 46 Ox Itchy palms, redness, nausea, shortness of breath Ox: 5 TCP M/ 68 Ox Dyspnea, abdominal pain, hypertension, tremors Not done F/ 63 Ox Palmar erythema, facial flushing and generalized rash Ox: 0.5 ID <0,10 <0,10 10 F/ 63 Ox Dyspnea, thoracic pain, generalized rash Not done F/ 70 Ox Generalized rash and hypotension Ox: 0.5 ID M/ 61 Ox Itchy palmar erythema, facial flushnig and urticaria on the trunk Ox: 0.5 ID <0,10 <0,10 F- female; M- male; Crb. Carboplatin; SPT- skin prick test; ID: intradermal 8
9 RISK ASSESSMENT The timing of carboplatin ST in relation to initial HSR is vital for risk stratification and subsequent desensitization. Initial ST negative patients with a remote history of HSR are at high risk for conversion to ST positive and can develop more severe HSR Risk stratification for desensitization of patients with carboplatin hypersensitivity: Clinical presentation and management J Allergy Clin Immunol 2009;123: TAXANES Anti-mytotic activity Treatment of several solid malignancies (ovary, breast, testicle, bladder) incidence of HSR before the 90 s ( > 40%) Inclusion of pre-medication with H1 and H2 anti-histamines and systemic corticosteroid in oncology protocols Incidence dropped to <10% Cross-reactivity? Paclitaxel: Cremophor Different solvents Docetaxel: Polysorbate 80 Substitutions may lead to similar reactions Dizon DSet al. Cross-sensitivity between paclitaxel and docetaxelin a women s cancers program. Gynecol Oncol 2006;100(1): TAXANES HSR usually occur on the 1 st or 2 nd infusions (95%) Mechanism still not identified Direct Mast Cell Activation and degranulation? Complement activation? But Clinical presentation similar to IgE immediate reactions Facial flushing Chest discomfort/pain Back pain Tachycardia Erythematous rash Hypotension Pruritus/urticaria Facial swelling - Pneumonitis - Maculopapular rash - Erythrodysesthesia plaque Skin testing persistently negative NOT RECOMMENDED! Clinical assessment and treatment similar to IgE immediate reactions 9
10 MONOCLONALS Their use in Oncology is rising Rituximab (lymphoma) Trastuzumab (Breast cancer) Cetuximab (metastatic colorectal cancer) Skin testing Prick full-strenght Intradermal up to 1:10 dilution Clinical presentation Similar to other chemotherapy agents Hypersensitivity reactions to mabs: 105 desensitizations in 23 patients, from evaluation to treatment J Allergy Clin Immunol 2009;123: Castells M. Drug desensitization in Oncology: chemotherapy agents and monoclonal antibodies. In Pichler WJ (Ed). Drug hypersensitivity.1st ed: Basel: Karger;2007: PATIENT SELECTION Hypersensitivity reactions to mabs: 105 desensitizations in 23 patients, from evaluation to treatment J Allergy Clin Immunol 2009;123: DESENSITIZATION Daily Practice: results Total of chemotherapy desensitizations 440 Total of chemotherapy agents 106 Total of patients 103 Platins Taxanes Anthracyclines Monoclonal Antibodies 10
11 Example of a 12-step standard desensitization protocol Name of medication: CARBOPLATIN Target Dose (mg) 500,0 Standard volume per bag (ml) 250 Final rate of infusion (ml/hr) 80 Calculated final concentration (mg/ml) 2 Standard time of infusion (minutes) 187,5 Total mg per bag 1/100 Solution ml of 0,020 mg/ml 5,000 1/10 Solution ml of 0,200 mg/ml 50,000 1/1 Solution ml of 1,984 mg/ml 496,065 *** PLEASE NOTE *** The total volume and dose dispensed are more than the final dose given to patient because many of the solutions are not completely infused Volume infused per Dose administered Cumulative dose (mg) Step Solution Rate (ml/hr) Time (min) step (ml) with this step (mg) 1 1 2,0 15 0,50 0,0100 0, ,0 15 1,25 0,0250 0, ,0 15 2,50 0,0500 0, ,0 15 5,00 0,1000 0, ,0 15 1,25 0,2500 0, ,0 15 2,50 0,5000 0, ,0 15 5,00 1,0000 1, , ,00 2,0000 3, ,0 15 2,50 4,9607 8, ,0 15 5,00 9, , , ,00 19, , ,0 174, ,50 461, , ,375 = 5,66 Total time (minutes) = hrs DESENSITIZATION Daily Practice: results CHEMOTHERAPY AGENT PATIENT/ DESENSITIZATION NUMBER SKIN TESTING Carboplatin (ovarian/neuroendocrine cancers) 24 / 98 PLATINS (n= 56 / 230) Oxaliplatin (colorectall/testicle cancer) Cisplatin (uterine cervix cancer) 29 / / 14 Positive= 53 Negative= 3 TAXANES (n= 45 / 174) Docetaxel (Breast cancer) 27 / 82 Paclitaxel (Ovarian/breast/Lung cancer) 18 / 92 ND ANTHRACYCLINES (n= 1 / 2) Liposomal Doxorrubycin 1 / 2 ND (retroperitoneal leiomyosarcoma) MONOCLONAL ANTIBODIES (n= 2 / 34) * ND: not done Trastuzumab (Breast cancer) 3 / 31 Cetuximab (colorectal cancer) 1 / 1 Trast - ND Cet neg DESENSITIZATION Treatment of the reactions - Cardiac monitor - Equipment for arterial pressure and oxygen saturation evaluation - Equipment for oxygen supply Complete emergency kit: Epinephrine 1:1000 for intramuscular administration I.V. Methylprednisolone I.V. Clemastine 2 mg I.V. Ranitidine 50 mg Inhaled Salbutamol 11
12 CHARACTERISTICS OF THE REACTIONS 46 REACTIONS (11.5%) - in 35 patients Mild 32 (7.2%) Moderate 10 (2.2%) Severe 4 (0.9%) 394 (89.5%) Oxali - 20 Carbo - 19 Cisplatin - 1 Paclitaxel %! Severe 4 (0.7%) Oxaliplatin - 2 Carboplatin - 2 Docetaxel - 3 Oxaliplatin - 4 Moderate 10 (2.4%) Carboplatin - 2 Paclitaxel - 2 Docetaxel 2 Carboplatin 15 Oxaliplatin - 14 Mild 32 (7.2%) Cisplatin - 1 Paclitaxel - 1 Docetaxel -1 MODIFICATIONS AFTER A HSR IMMEDIATELY AFTER THE HSR Hold infusion Treat according to the protocol Resume desensitization EXACTLY at the point it was held ADAPTATIONS IN FURTHER INFUSIONS When there is only mild reaction, do not alter the protocol Premedicate with clemastine and methylprednisolone before the step at which the patient has reacted Add 1 or 2 additional steps In step 12, reduce the maximum rate to 75 or 60 ml/h Initiate with a 1/1000 dilution instead of 1/100 (16-step protocol) When recurrent HSR have occurred or when the initial reaction was moderate to severe, especially with platins Pre-medicate with aspirin and montelukast 2 days prior to the desensitization Breslow R et al. Acetylsalicylic acid and montelukast block mast cell mediator -related symptoms during rapid desensitization. Ann Allergy Asthma Immunol 2009 Feb;102(2): MODIFICATIONS AFTER A HSR Breslow R, Caiado J, Castells MCl. Acetylsalicylic acid and montelukast block mast cell mediator -related symptoms during rapid desensitization. Ann Allergy Asthma Immunol 2009 Feb;102(2):
13 FINAL COMMENTS Clinical assessment and risk stratification of HRS is crucial Skin testing may predict anaphylactic reactions to platinum-type drugs Similar clinical approach os immediate reactions (IgE and non-ige mediated) Importance in selection of patients amenable for desensitized Learn how to design and adapt a desensitization protocol Some patients may need special premedication protocols Desensitization procedures allow the reintroduction of chemotherapy agents in patients with previous HSR. From our experience, the majority of patients (426 97%) tolerated the procedure with only mild or no HSR. 13
A safe protocol for rapid desensitization in patients with cystic fibrosis and antibiotic hypersensitivity
Journal of Cystic Fibrosis 8 (2009) 418 424 www.elsevier.com/locate/jcf Short communication A safe protocol for rapid desensitization in patients with cystic fibrosis and antibiotic hypersensitivity Henry
More informationA protocol for risk stratification of patients with carboplatin-induced hypersensitivity reactions
Food, drug, insect sting allergy, and anaphylaxis A protocol for risk stratification of patients with carboplatin-induced hypersensitivity reactions Sarita U. Patil, MD, Aidan A. Long, MD, Morris Ling,
More informationVACCINE-RELATED ALLERGIC REACTIONS
VACCINE-RELATED ALLERGIC REACTIONS Management of Anaphylaxis Public Health Immunization Program June 2018 VACCINE-RELATED ADVERSE EVENTS Local reactions pain, edema, erythema Systemic reactions fever,
More informationUrticaria Moderate Allergic Reaction Mild signs/symptoms with any of following: Dyspnea, possibly with wheezes Angioneurotic edema Systemic, not local
Allergic Reactions & Anaphylaxis Incidence In USA - 400 to 800 deaths/year Parenterally administered penicillin accounts for 100 to 500 deaths per year Hymenoptera stings account for 40 to 100 deaths per
More informationVACCINE-RELATED ALLERGIC REACTIONS
VACCINE-RELATED ALLERGIC REACTIONS Management of Anaphylaxis IERHA Immunization Program September 2016 VACCINE-RELATED ADVERSE EVENTS Local reactions pain, edema, erythema Systemic reactions fever, lymphadenopathy
More informationAnaphylaxis: Treatment in the Community
: Treatment in the Community is likely if a patient who, within minutes of exposure to a trigger (allergen), develops a sudden illness with rapidly progressing skin changes and life-threatening airway
More informationEPIPEN INSERVICE Emergency Administration of Epinephrine for the Basic EMT. Michael J. Calice MD, FACEP St. Mary Mercy Hospital
EPIPEN INSERVICE Emergency Administration of Epinephrine for the Basic EMT Michael J. Calice MD, FACEP St. Mary Mercy Hospital Case #1 NR is an 8 yo male c/o hot mouth and stomach ache after eating jelly
More informationPath2220 INTRODUCTION TO HUMAN DISEASE ALLERGY. Dr. Erika Bosio
Path2220 INTRODUCTION TO HUMAN DISEASE ALLERGY Dr. Erika Bosio Research Fellow Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research University of Western Australia
More informationPenicillin Allergy and Use of Other Antibiotics
Penicillin Allergy and Use of Other Antibiotics 7300-646PT Policy No.: 7310-646PT 8790-646PT Original Policy Date: 10/10/2016 Revision Date(s): Review Date(s): Approval: 11/17/16 Pharmacy & Therapeutics
More informationSupplementary Online Content
Supplementary Online Content Shenoy E, Macy E, Rowe TA, Blumenthal KG. Evaluation and management of penicillin allergy. JAMA. doi:10.1001/jama.2018.19283 Table 1. Hypersensitivity reaction types Table
More informationAnaphylaxis: treatment in the community
: treatment in the community Item Type Guideline Authors Health Service Executive Citation Health Service Executive. : treatment in the community. Dublin: Health Service Executive;. 5p. Publisher Health
More informationChemotherapy Hypersensitivity Reactions in Ovarian Cancer
Original Article 389 Chemotherapy Hypersensitivity Reactions in Ovarian Cancer Matthieu Picard, MD a ; Ursula A. Matulonis, MD b ; and Mariana Castells, MD, PhD a Abstract Ovarian cancer is the fifth leading
More informationCycle 1 PERTuzumab (day 1) and trastuzumab (day 2) loading doses: Drug Dose BC Cancer Administration Guideline
BC Cancer Protocol Summary for Palliative Therapy for Metastatic Breast Cancer Using PERTuzumab, Trastuzumab (HERCEPTIN), and PACLItaxel as First-Line Treatment for Advanced Breast Cancer Protocol Code:
More informationWho Should Be Premediciated for Contrast-Enhanced Exams?
Who Should Be Premediciated for Contrast-Enhanced Exams? Jeffrey C. Weinreb, MD,FACR Yale University School of Medicine jeffrey.weinreb@yale.edu Types of Intravenous Contrast Media Iodinated Contrast Agents
More informationManagement of Infusion Reactions to Taxane Based Chemotherapy: Review Article
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 6 Ver. III (June. 2016), PP 22-26 www.iosrjournals.org Management of Infusion Reactions to
More informationPedsCases Podcast Scripts
PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on Drug Allergy. These podcasts are designed to give medical students an overview of key topics in pediatrics. The audio
More informationDr Alex Bradshaw Consultant Clinical Oncologist Sept 2016
Dr Alex Bradshaw Consultant Clinical Oncologist Sept 2016 Learning Points Recognising Acute Drug Reactions Preventing Acute Drug Reactions Treating Acute Drug Reactions Anaphylaxis Recognising Anaphylaxis
More informationMyth: Prior Episodes Predict Future Reactions REALITY: No predictable pattern Severity depends on: Sensitivity of the individual Dose of the allergen
Myth: Prior Episodes Predict Future Reactions REALITY: No predictable pattern Severity depends on: Sensitivity of the individual Dose of the allergen Anaphylaxis Fatalities Estimated 500 1000 deaths annually
More information8/8/2016. Overview. Back to Basics: Immunology. Adverse Reactions to Drugs: Dispelling Myths
Adverse Reactions to Drugs: Dispelling Myths Allison Ramsey, MD NPA Annual Conference September 30, 2016 Overview Review of types of hypersensitivity reactions Penicillin allergy IV contrast allergy Local
More informationStudent Health Center
Referring Allergist Agreement Your patient is requesting that the University of Mary Washington Student Health Center (UMWSHC) administer allergy extracts provided by your office. Consistent with our policies
More informationAllergic Reactions and Anaphylaxis. William Mapes, NRP, I/C Chief, Brandon Area Rescue Squad Brandon, VT
Allergic Reactions and Anaphylaxis William Mapes, NRP, I/C Chief, Brandon Area Rescue Squad Brandon, VT Allergy to Anaphylaxis Defined as a histamine-mediated spectrum of physiologic events that include:
More informationBRAJACTT. Protocol Code. Breast. Tumour Group. Dr. Karen Gelmon. Contact Physician
BC Cancer Protocol Summary for Adjuvant Therapy for Breast Cancer using DOXOrubicin and Cyclophosphamide followed by PACLitaxel and Trastuzumab (HERCEPTIN) Protocol Code Tumour Group Contact Physician
More informationImmunocompetence The immune system responds appropriately to a foreign stimulus
Functions of the immune system Protect the body s internal environment against invading organisms Maintain homeostasis by removing damaged cells from the circulation Serve as a surveillance network for
More informationALLERGIC EMERGENCIES 5/8/2015. Objectives for Pharmacists. Patient Case. Objectives for Technicians. Definition of Anaphylaxis.
ALLERGIC EMERGENCIES Kristina Dawson, PharmD, BCPS Objectives for Pharmacists Describe the immunologic pathways to cause an allergic response Identify the most common triggers to cause Choose the appropriate
More informationAnaphylaxis: The Atypical Varieties
Anaphylaxis: The Atypical Varieties John Johnson, D.O., PGY-4 Allergy/Immunology Fellow University Hospitals of Cleveland Case Western Reserve University School of Medicine Disclosures: None What is Anaphylaxis?
More informationAllergic Emergencies and Anaphylaxis. George Porfiris MD, CCFP(EM),FCFP TEGH
Allergic Emergencies and Anaphylaxis George Porfiris MD, CCFP(EM),FCFP TEGH Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted
More informationBC Cancer Protocol Summary for Adjuvant Therapy for Breast Cancer Using Weekly PACLitaxel and Trastuzumab (HERCEPTIN)
BC Cancer Protocol Summary for Adjuvant Therapy for Breast Cancer Using Weekly PACLitaxel and Trastuzumab (HERCEPTIN) Protocol Code: Tumour Group: Contact Physician: UBRAJTTW Breast Dr. Angela Chan ELIGIBILITY:
More informationDERBY-BURTON LOCAL CANCER NETWORK FILENAME Peruse.DOC CONTROLLED DOC NO: CCPG R29
Pertuzumab + Trastuzumab + Docetaxel (Peruse study) A Multicenter, open-label, single arm study of Pertuzumab in combination with Trastuzumab and a Taxane in first-line treatment of patients with HER2-positive
More informationTREATMENT OF ANAPHYLACTIC REACTION WITH EPINEPHRINE
TREATMENT OF ANAPHYLACTIC REACTION WITH EPINEPHRINE FILE: JGCDC Background: The Bibb County School System recognizes the growing concern with severe life-threatening allergic reactions to food items, latex,
More informationTitle: Management of Allergic Reactions after IV Contrast in Magnetic Resonance Imaging
ABSTRACT FOR SPS POSTER CASE PRESENTATION K Singer Title: Management of Allergic Reactions after IV Contrast in Magnetic Resonance Imaging Introduction: Children undergoing radiologic imaging frequently
More informationTerms What is Anaphylaxis? Causes Signs & Symptoms Management Education Pictures Citations. Anaphylaxis; LBodak
Leslie Bodak, EMT-P Terms What is Anaphylaxis? Causes Signs & Symptoms Management Education Pictures Citations Allergic Reaction: an abnormal immune response the body develops when a person has been previously
More informationMast Cell Disorders. Andrew M. Smith, MD, MS
Mast Cell Disorders Andrew M. Smith, MD, MS Division of Immunology, Allergy, and Rheumatology University of Cincinnati and Cincinnati VA Medical Centers August 10 and 11, 2012 Disclosures None The contents
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Burks AW, Jones SM, Wood RA, et al. Oral immunotherapy for
More informationMANAGING COMMON PRESENTATIONS OF ALLERGY IN PRIMARY CARE. Helen Bourne Consultant Immunologist
MANAGING COMMON PRESENTATIONS OF ALLERGY IN PRIMARY CARE Helen Bourne Consultant Immunologist AIMS Presentation of Allergic Disease in Adults Rhinitis/ Rhinoconjuctivitis Urticaria and Angioedema Food
More informationBRAVTPCARB. Protocol Code: Breast. Tumour Group: Dr. Karen Gelmon. Contact Physician:
BCCA Protocol Summary for Palliative Therapy for Metastatic Breast Cancer using Trastuzumab (HERCEPTIN), PACLitaxel and CARBOplatin as First-Line Treatment for Advanced Breast Cancer Protocol Code: Tumour
More informationManagement of an immediate adverse event following immunisation
Management of an immediate adverse event following immunisation The vaccinated person should remain under observation for a short interval to ensure that they do not experience an immediate adverse event.
More informationTransfusion Reactions
Transfusion Reactions From A to T Provincial Blood Coordinating Program Daphne Osborne MN PANC (C) RN We want you to know Definition Appropriate actions Classification Complete case studies Transfusion
More informationCarboplatin / Liposomal Doxorubicin CARBO/CAELYX Gynaecological Cancer
Systemic Anti Cancer Treatment Protocol Carboplatin / CARBO/CAELYX Gynaecological Cancer PROCTOCOL REF: MPHAGYNCCX (Version No: 1.0) Approved for use in: Advanced ovarian cancer in women who have progressed
More information: ALLERGIC REACTION
6208.05: ALLERGIC REACTION INTRODUCTION Allergic (hypersensitivity) reactions are most often secondary to an exaggerated immune system response to a harmless foreign antigen (e.g. insect bite or sting,
More informationPrimary Care practice clinics within the Edmonton Southside Primary Care Network.
Administration of Immunizations Last Review: November 2016 Intervention(s) and/or Procedure: Practice Setting: Authorized Implementers: Competencies and Educational Requirements: Administration of immunizations
More informationAdult Hypersensitivity (HSR)/Allergic Reaction Management
Page 1 of 5 Patient with HSR to medication (For blood product related HSR see Page 2) PRESENTING SYMPTOMS Fever 1, chills, and/or rigors Acetaminophen within 4 hours or Stem Cell Transplant patient? Call
More informationPRIMARY CARE PRACTICE GUIDELINES
Community Mgmt Team - 1 of 6 1. OUTCOME To identify anaphylaxis in the primary care setting and provide an evidence informed emergency response utilizing the most current provincial and federal practice
More informationAllergy Immunotherapy in the Primary Care Setting
Allergy Immunotherapy in the Primary Care Setting New York State College Health Association 2008 COMBINED ANNUAL MEETING October 2008 Mary Madsen RN BC University of Rochester Issues in Primary Care Practice
More informationBC Cancer Protocol Summary for Treatment of Chronic Lymphocytic Leukemia or Prolymphocytic Leukemia with Fludarabine and rituximab
BC Cancer Protocol Summary for Treatment of Chronic Lymphocytic Leukemia or Prolymphocytic Leukemia with Fludarabine and rituximab Protocol Code Tumour Group Contact Physicians LYCLLFLUDR Lymphoma Dr.
More informationLEMTRADA REMS Education Program for Healthcare Facilities
For Healthcare Facilities LEMTRADA REMS Education Program for Healthcare Facilities This Educational Piece Includes Information About: The LEMTRADA REMS Program requirements to implement in your healthcare
More informationAn allergic reaction is an exaggerated response by the immune system to a foreign substance
ALLERGIC REACTION An allergic reaction is an exaggerated response by the immune system to a foreign substance Anaphylaxis is an unusual or exaggerated allergic reaction; is a life threatening emergency
More informationPrimary Care practice clinics within the Edmonton Southside Primary Care Network.
Allergy/Immunotherapy Injections Last Review: November 2016 Intervention(s) and/or Procedure: Administration of allergen injections throughout immunotherapy treatment. Immunotherapy for allergic disease
More informationManagement of ANAPHYLAXIS in the School Setting. Updated September 2010
Management of ANAPHYLAXIS in the School Setting Updated September 2010 What is an Allergy? Allergies occur when the immune system becomes unusually sensitive and over reacts to common substance that are
More informationEmergency Department Guideline. Anaphylaxis
Emergency Department Guideline Inclusion criteria: 1. Acute onset of an illness (minutes to hours) with a AND (b OR c): a. Skin and/or mucosa (pruritus, flushing, hives, angioedema) b. Respiratory compromise
More informationAllergy Management Policy
Allergy Management Policy Food Allergy People with allergies have over-reactive immune systems that target otherwise harmless elements of our diet and environment. During an allergic reaction to food,
More informationChapter 8. Learning Objectives. Learning Objectives 9/11/2012. Anaphylaxis. List symptoms of anaphylactic shock
Chapter 8 Anaphylaxis Learning Objectives List symptoms of anaphylactic shock Discuss role of immune system in fighting antigens Define allergic response Learning Objectives Describe body s response to
More informationMichaela Lucas. Clinical Immunologist/Immunopathologist. Pathwest, QE2 Medical Centre, Princess Margaret Hospital
Michaela Lucas Clinical Immunologist/Immunopathologist Pathwest, QE2 Medical Centre, Princess Margaret Hospital School of Medicine and Pharmacology, School of Pathology and Laboratory Medicine University
More informationAllergy in Personnel with Laboratory Animal Contact. Horatiu V. Vinerean DVM, DACLAM Director, Laboratory Animal Research Attending Veterinarian
Allergy in Personnel with Laboratory Animal Contact Horatiu V. Vinerean DVM, DACLAM Director, Laboratory Animal Research Attending Veterinarian Significance Allergy incidence - some estimate that as many
More informationULYRICE. Protocol Code. Lymphoma. Tumour Group. Dr. Laurie Sehn. Contact Physician
BCCA Protocol Summary for the Treatment of Relapsed or Refractory Advanced Stage Aggressive B-Cell Non-Hodgkin s Lymphoma with Ifosfamide, CARBOplatin, Etoposide and rituximab Protocol Code Tumour Group
More informationPM-03 PED ALLERGY/ANAPHYLAXIS. Protocol SECTION: PM-03 PROTOCOL TITLE: PED ALLERGY/ANAPHYLAXIS REVISED: 01MAY2018
SECTION: PROTOCOL TITLE: REVISED: 01MAY2018 BLS SPECIFIC CARE: See General Pediatric Care Protocol PM-1 - Determine patient s color category on length based resuscitation tape (Broselow Tape) Epi Pen Protocol
More informationPrevention and handling of acute allergic and infusion reactions in oncology
Annals of Oncology 23 (Supplement 10): x313 x319, 2012 doi:10.1093/annonc/mds314 Prevention and handling of acute allergic and infusion reactions in oncology M. Joerger Department of Oncology and Hematology,
More informationAs you begin this build-up phase there are several factors to keep in mind concerning your treatment:
SLIT IMMUNOTHERAPY INSTRUCTIONS David R. Scott, M.D./William A. Scott, M.D. Congratulations on beginning your new sublingual immunotherapy (SLIT) prescription! The initial 30 doses are advancement doses.
More informationOBJECTIVES DEFINITION TYPE I HYPERSENSITIVITY TYPES OF HYPERSENSITIVITY ACUTE ALLERGIC REACTION 11/5/2016
OBJECTIVES ACUTE ALLERGIC REACTION Wei Zhao, MD, PhD Ambulatory Medical Director Children s Hospital of Richmond at VCU Associate Professor, Chief Chief, Division of Allergy and Immunology Virginia Commonwealth
More informationAnaphylaxis. Choosing Wisely with Academic Detailing Conference October 21, 2017
Anaphylaxis Choosing Wisely with Academic Detailing Conference October 21, 2017 Disclosure Natasha Rodney-Cail, Pharmacist, Drug Evaluation Unit DEU funded by the Drug Evaluation Alliance of Nova Scotia
More informationHerceptin IV (Trastuzumab) and Paclitaxel Cumbria, Northumberland, Tyne & Wear Area Team
DRUG ADMINISTRATION SCHEDULE Given as a three weekly schedule Day Drug Daily Dose Route Diluent & Rate On first cycle 250mls Normal Saline Herceptin IV 8 mg/kg Infusion only 90 mins On other 250mls Normal
More informationChapter 65 Allergy and Immunology for the Internist. ingestion provoke an IgE antibody response and clinical symptoms in sensitive individuals.
Chapter 65 Allergy and Immunology for the Internist 1 I. Basic Information A. Definition of Allergens: Proteins of appropriate size that after inhalation, injection (e.g. drug, venom) or ingestion provoke
More informationThis leaflet answers some common questions about HERCEPTIN SC. It does not contain all the available information.
Consumer Medicine Information HERCEPTIN SC Trastuzumab 600 mg/5 ml solution for subcutaneous injection What is in this leaflet This leaflet answers some common questions about HERCEPTIN SC. It does not
More informationLiposomal Doxorubicin (CAELYX) Gynaecological Cancer
Systemic Anti Cancer Treatment Protocol Liposomal Doxorubicin (CAELYX) Gynaecological Cancer PROCTOCOL REF: OPHAGYNCAE (Version No: 1.0) Approved for use in: Advanced ovarian cancer second/third line treatment
More informationAllergic Reactions and Envenomations. Chapter 16
Allergic Reactions and Envenomations Chapter 16 Allergic Reactions Allergic reaction Exaggerated immune response to any substance Histamines and leukotrienes Chemicals released by the immune system Anaphylaxis
More informationBC Cancer Protocol for Treatment of Platinum Resistant Epithelial Ovarian Cancer with Bevacizumab and PACLitaxel
BC Cancer Protocol for Treatment of Platinum Resistant Epithelial Ovarian Cancer with Bevacizumab and PACLitaxel Protocol Code Tumour Group Contact Physician UGOOVBEVP Gynecologic Oncology Dr. Anna Tinker
More informationAdministration Tear Pad
for WG and Administration Tear Pad The first and ONLy FDA-approved therapy for Wegener s granulomatosis (WG) AND microscopic polyangiitis () Inside: Patient Checklist and Chart Record Preparation and Administration
More informationBlood/Blood Component Utilization and Administration Annual Compliance Education
Blood/Blood Component Utilization and Administration Annual Compliance Education This course contains annual compliance education necessary to meet compliance and regulatory requirements. Instructions:
More informationChemotherapy must not be started unless the following drugs have been given:
BC Cancer Protocol Summary for Second-Line Therapy for Metastatic or Locally Advanced Gastric or Gastroesophageal Junction Cancer Using Weekly PACLitaxel and Ramucirumab Protocol Code: Tumour Group: Contact
More informationHerceptin (Trastuzumab) plus Capecitabine & Cisplatin (HCX)
Herceptin (Trastuzumab) plus Capecitabine & Cisplatin (HCX) DRUG ADMINISTRATION SCHEDULE First Cycle Only: Day Drug Daily Dose Route Diluent and Rate 1 to 21 Capecitabine 625mg/m 2 Day 1 TWICE DAILY Oral
More informationManagement of Hypersensitivity Reactions: A Nursing Perspective
Management of Hypersensitivity Reactions: A Nursing Perspective Review Article [1] February 01, 2009 By Pamela Hallquist Viale, RN, MS, CS [2] Oncology clinicians administer monoclonal antibodies (MoAbs)
More informationAn unpredictable, dose-independent adverse drug reaction which is immunologically or IgEmediated.
R H E U M A T I S M D I S O R D E R S A N D A L L E R G I E S APPROACH TO DRUG ALLERGY Dr Bernard Thong DEFINITION OF DRUG ALLERGY An unpredictable, dose-independent adverse drug reaction which is immunologically
More informationHave you ever managed patients who have experienced an adverse reaction to transfusion?
Have you ever managed patients who have experienced an adverse reaction to transfusion? A. Yes, often B. Yes, occasionally C. No A. 1 in 30 units? B. 1 in 100? C. 1 in 1000? D. 1 in 10,000? SHOT collects
More informationRiTUXimab 375 mg/m 2 Therapy-7 day
RiTUXimab 375 mg/m 2 Therapy-7 day This regimen supercedes NCCP Regimen 00208 rituximab 375mg/m2 therapy-follicular lymphoma as of February 2019 INDICATIONS FOR USE: Regimen *Reimbursement INDICATION ICD10
More informationAllergy & Anaphylaxis
Allergy & Anaphylaxis (why, where, and what to do) Robert H. Brown, M.D., M.P.H. Professor Departments of Anesthesiology, Environmental Health Sciences, Medicine, and Radiology The Johns Hopkins Medical
More informationDatabase of Adverse Event Notifications - medicines
Database of Adverse Event Notifications - medicines You searched for the following 3 medicines between 01/01/2017 01/01/2018: Ferinject 100mg/2mL (Ferric carboxymaltose) Ferinject 500mg/10mL (Ferric carboxymaltose)
More informationBRAJACTTG. Protocol Code. Breast. Tumour Group. Dr. Karen Gelmon. Contact Physician
BC Cancer Protocol Summary for Adjuvant Therapy for Breast Cancer Using Dose Dense Therapy: DOXOrubicin and Cyclophosphamide Followed by PACLitaxel and Trastuzumab (HERCEPTIN) Protocol Code Tumour Group
More informationEczema: also called atopic dermatitis; a chronic, itchy, scaly rash not due to a particular substance exposure
Allergy is a condition in which the immune system causes sneezing, itching, rashes, and wheezing, or sometimes even life-threatening allergic reactions. The more you know about allergies, the better prepared
More informationPolicy for the Treatment of Anaphylaxis in Adults and Children
Policy for the Treatment of Anaphylaxis in Adults and Children June 2008 Policy Title: Policy for the Treatment of Anaphylaxis in Adults or Children Policy Reference Number: PrimCare08/17 Implementation
More informationAnaphylaxis/Latex Allergy
Children s Acute Transport Service CATS Clinical Guideline Anaphylaxis/Latex Allergy Document Control Information Author D Lutman Author Position Consultant Document Owner E Polke Document Owner Position
More informationHCX Herceptin, Cisplatin and Capecitabine
DRUG ADMINISTRATION SCHEDULE First Cycle Only: Day Drug Daily Dose Route Diluent Rate Sodium Chloride 0.9% 250 ml Infusion Fast Running Day 1 Furosemide 20mg IV bolus Via saline drip Trastuzumab 8mg/kg
More informationThey are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:
bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest
More informationWhat ERBITUX does. Use in Children. The effectiveness of ERBITUX in children under the age of 18 years has not been established.
cetuximab (rmc) Consumer Medicine Information What is in this leaflet This leaflet answers some common questions about ERBITUX. It does not contain all the available information. It does not take the place
More informationPOLICY MANUAL Section 5 NO: Anaphylaxis/Life Threatening Medical Conditions -POLICY-
Anaphylaxis/Life Threatening Medical Conditions -POLICY- The Board of Education is committed to the principle of providing a safe learning environment for its students. This includes a safe environment
More informationASDIN 10th Annual Scientific Meeting Final. COI Disclosure Statement. Intravenous Contrast Media: Basics
COI Disclosure Statement There are no financial relationships or conflicts of interest to disclose with this presentation Melissa Hicks, BA, RT(R)(VI) Vascular Interventional Technologist University of
More informationINVESTIGATION OF ADVERSE TRANSFUSION REACTIONS TABLE OF RECOMMENDED TESTS. Type of Reaction Presentation Recommended Tests Follow-up Tests
Minor Allergic (Urticarial) Urticaria, pruritis, flushing, rash If skin reaction only and mild hives/ rash
More information, version 1.1 PUBLIC SUMMARY OF THE RISK MANAGEMENT PLAN
Docetaxel Orion 20 mg/1 ml concentrate for solution for infusion Docetaxel Orion 80 mg/4 ml concentrate for solution for infusion Docetaxel Orion 160 mg/8 ml concentrate for solution for infusion 11.8.2014,
More informationPACKAGE INSERT USP ANTIBIOTIC
Pr AMPICILLIN for Injection USP ANTIBIOTIC ACTIONS AND CLINICAL PHARMACOLOGY Ampicillin has a broad spectrum of bactericidal activity against many gram-positive and gramnegative aerobic and anaerobic bacteria.
More informationPACKAGE LEAFLET: INFORMATION FOR THE USER. Cinfalair 4 mg chewable tablets
PACKAGE LEAFLET: INFORMATION FOR THE USER Cinfalair 4 mg chewable tablets Read all of this leaflet carefully before your child starts taking this medicine. Keep this leaflet. You may need to read it again.
More informationDocetaxel + Carboplatin + Trastuzumab
Docetaxel + Carboplatin + Trastuzumab Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case Burton community Derby community Burton out-patient Derby out-patient
More informationConscious Sedation Permit Evaluation. General Comments Emergency Algorithms
General Comments Emergency Algorithms These algorithms delineate appropriate responses to the simulated emergencies listed in Article 5, Section 1043.4c of the California Code of Regulations. Each algorithm
More informationPharmaceutical form(s)/strength: Solution: 5 mg/ml Suspensions: 2.5 and 5 mg/ml P-RMS:
0BCore Safety Profile Active substance: Betaxolol eyedrops Pharmaceutical form(s)/strength: Solution: 5 mg/ml Suspensions: 2.5 and 5 mg/ml P-RMS: HU/H/PSUR/0010/002 Date of FAR: 20.03.2013 4.2 Posology
More informationDAP Clavulanic Powder and solvent for injectable suspension.
DAP Clavulanic Powder and solvent for injectable suspension. Read all of this leaflet carefully before you start using this medicine because it contains important information fon you. - Keep this leaflet.
More informationFood allergy in children. nice bulletin. NICE Bulletin Food Allergy in Chlidren.indd 1
nice bulletin Food allergy in children NICE provided the content for this booklet which is independent of any company or product advertised NICE Bulletin Food Allergy in Chlidren.indd 1 23/01/2012 11:04
More informationBRLAACDT. Protocol Code. Breast. Tumour Group. Dr. Karen Gelmon. Contact Physician
BCCA Protocol Summary for Treatment of Locally Advanced Breast Cancer using DOXOrubicin and Cyclophosphamide followed by DOCEtaxel and Trastuzumab (HERCEPTIN) Protocol Code Tumour Group Contact Physician
More informationBCCA Protocol for Primary Treatment of Metastatic or Recurrent Cancer of the Cervix with Bevacizumab, CARBOplatin and PACLitaxel
BCCA Protocol for Primary Treatment of Metastatic or Recurrent Cancer of the Cervix with Bevacizumab, CARBOplatin and PACLitaxel Protocol Code Tumour Group Contact Physician GOCXCATB Gynecologic Oncology
More informationMabThera. SC. The wait is over. MabThera delivered in just 5 minutes. SC= subcutaneous injection
MabThera SC. The wait is over. MabThera delivered in just 5 minutes Abbreviated Prescribing Information MabThera 1400 mg solution for subcutaneous (SC) injection (Rituximab) Indications: Indicated in adults
More informationShelley Westwood, RN, BSN
Shelley Westwood, RN, BSN The body requires a constant supply of oxygen for survival. AMERICAN RED CROSS FIRST AID RESPONDING TO EMERGENCIES FOURTH EDITION Copyright 2006 by The American National Red Cross
More informationAnaphylaxis School First results of a national multicenter study
Anaphylaxis School First results of a national multicenter study J. Kupfer, S. Schallmayer, I. Fell, U. Gieler for the German study group Anaphylaxis is an acute, potentially life-threatening hypersensitivity
More information