Soyer Ozge Uysal, Aytac Selin, Tuncer Ayfer, Cetin Mualla, Yetgin Sevgi, Sekerel Bulent Enis
Pediatric Allergy and Asthma Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey.
J Allergy Clin Immunol. 2009 Apr;123(4):895-9. doi: 10.1016/j.jaci.2008.10.034. Epub 2008 Dec 10.
L-asparaginase is a crucial chemotherapeutic agent for the treatment of acute lymphoblastic leukemia. The alternatives to L-asparaginase are not available in many parts of the world, including Turkey.
We sought to evaluate the utility of premedication with or without a desensitization protocol in children with acute lymphoblastic leukemia and systemic hypersensitivity reactions to Escherichia coli-asparaginase.
In this prospective study patients with systemic hypersensitivity reactions to E coli-asparaginase for whom we were unable to ascertain/provide other alternatives to asparaginase were either premedicated, desensitized, or both to receive their chemotherapy as E coli-asparaginase according to the severity of the hypersensitivity reaction.
Nineteen patients (13 male patients) with a mean age of 7.4 +/- 4.7 years experienced a systemic hypersensitivity reaction to E coli-asparaginase during a 4-year period. Polyethylene glycol-asparaginase could be used for 3 patients. Eight of the remaining 16 children, who had experienced anaphylaxis, were premedicated and desensitized with E coli-asparaginase, and in 7 patients treatment was tolerated. The other 8 patients, with acute allergic reactions to E coli-asparaginase, were premedicated first, and 5 of them showed no reaction subsequently. Three of them demonstrated systemic hypersensitivity reactions again (anaphylaxis, n = 3), and premedication and desensitization with E coli-asparaginase resulted in anaphylaxis. Polyethylene glycol-asparaginase was administered uneventfully to the patients who could be provided it.
E coli-asparaginase could be administered to more than half of the patients who had a hypersensitivity reaction, and all of these patients were able to receive their planned doses of asparaginase. In countries with shortages of alternative asparaginase preparations, our approach might be a suitable option.
L-天冬酰胺酶是治疗急性淋巴细胞白血病的关键化疗药物。在世界许多地区，包括土耳其，都没有L-天冬酰胺酶的替代药物。
我们试图评估在急性淋巴细胞白血病且对大肠杆菌天冬酰胺酶有全身过敏反应的儿童中，使用或不使用脱敏方案进行预处理的效用。
在这项前瞻性研究中，对于对大肠杆菌天冬酰胺酶有全身过敏反应且我们无法确定/提供天冬酰胺酶其他替代药物的患者，根据过敏反应的严重程度，要么进行预处理，要么进行脱敏，要么两者都进行，以便接受大肠杆菌天冬酰胺酶化疗。
在4年期间，19名患者（13名男性患者）平均年龄为7.4±4.7岁，对大肠杆菌天冬酰胺酶发生了全身过敏反应。3名患者可以使用聚乙二醇天冬酰胺酶。其余16名发生过敏反应的儿童中，8名先用大肠杆菌天冬酰胺酶进行预处理和脱敏，7名患者耐受治疗。另外8名对大肠杆菌天冬酰胺酶有急性过敏反应的患者首先进行预处理，其中5名随后未出现反应。其中3名再次出现全身过敏反应（过敏反应，n = 3），用大肠杆菌天冬酰胺酶进行预处理和脱敏导致过敏反应。对于能够获得聚乙二醇天冬酰胺酶的患者，给予该药物时未出现问题。
对过敏反应患者中超过一半可以给予大肠杆菌天冬酰胺酶，所有这些患者都能够接受计划剂量的天冬酰胺酶。在替代天冬酰胺酶制剂短缺的国家，我们的方法可能是一个合适的选择。
