Immediate type hypersensitivity to chemotherapeutic agents in pediatric patients.

Nine patients (3 boys and 6 girls) with a median age of 9.5 years, with immediate type hypersensitivi-ty reactions to chemotherapeutic agents were reviewed. The presenting symptoms were urticaria (4/9) and ana-phylaxis (5/9). The causative agents were vincristine (2/9), L-asparaginase (2/9), mesna (1/9), cyclosporine (1/9), carboplatin (2/9) and cyclophosphamide (1/9). Three of the five patients with anaphylaxis were changed to alterna-tive chemotherapeutic agents. In two cases alternative drugs were not available and the patients underwent safe and successful desensitization. Three of the 4 patients with urticaria were successfully exposed to graded chal-lenges with cyclosporine, carboplatin and cyclophosphamide, respectively. In the other case with generalized urti-caria, mesna was withdrawn due to a positive intradermal test. In patients with immediate type hypersensitivity reactions to chemotherapeutic drugs, if effective alternative chemotherapeutic agents are not available and/or the skin test is negative, a careful drug challenge and/or desensitization should be performed.