of Vancouver General Hospital. Prepared by the Pharmaceutical Sciences Clinical Services Unit by authority of the Drugs & Therapeutics Committee and the Medical & Academic Advisory Committee.

APPENDIX VIII:  MANAGEMENT OF ANAPHYLACTIC REACTIONS CAUSED BY ANTINEOPLASTIC THERAPY

Anaphylactic reactions are rare complications of antineoplastic therapy. Only a few drugs cause anaphylaxis with any frequency, but they may occur at any time and with any drug.  Most frequently, anaphylactic reactions occur with one of the first exposures to the drug and characteristically they occur almost immediately after an injection or IV infusion.  The sudden onset of anaphylaxis may consist of one or more of the following:

1. hypotension

2. tachycardia or bradycardia

3. wheezing, respiratory distress, upper airway obstruction

4. generalized urticaria and/or edema

If untreated, symptoms may rapidly progress to vascular collapse with cardiorespiratory arrest and death.

The immediate treatment is:

1. stop the administration of the drug (if possible)

2. IV epinephrine (start with 0.2-0.5 mg and repeat every 5 minutes until B.P. begins to recover

3. IV hydrocortisone 100-250 mg

4. IV normal saline rapidly to support volume

5. maintain airway, intubation and ventilation may be needed

Rev. January 1991