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A Desensitization Protocol in Children With L-Asparaginase Hypersensitivity

Akbayram, Sinan MD*; Doğan, Murat MD; Akgün, Cihangir MD; Çaksen, Hüseyin MD; Öner, Ahmet Faik MD*

Journal of Pediatric Hematology/Oncology: July 2010 - Volume 32 - Issue 5 - p e187-e191
doi: 10.1097/MPH.0b013e3181e003c7
Online Articles: Original Articles

Background L-asparaginase is effective in the treatment of malignant diseases, but it has been associated with hypersensitivity reactions in 5% to 45% of the patients.

Purpose To determine whether a desensitization protocol in children with native Escherichia coli L-asparaginase hypersensitivity allows subsequent safe administration of native E. coli L-asparaginase.

Patients and Methods A desensitization protocol was used in 9 children with leukemia (n=8) or Langerhans cell histiocytosis (n=1) and previous severe (n=4) or mild/moderate (n=5) L-asparaginase hypersensitivity. Dexamethasone (2 mg/kg intravenously) and pheniramine hydrogen maleate (1 mg/kg intravenously) were administered 1 hour before each of the following L-asparaginase administrations. Subsequently, 0.1%, 1%, 5%, 10%, and the remaining 84% of the total dose of L-asparaginase (10,000 IU/m2) were each prepared in 240 mL 0.9% saline and infused over 4 hours (20 h in total).

Results After desensitization, none of the patients had recurrence of hypersensitivity reactions during the subsequent 2 to 15 doses (median: 6 doses/patient; 68 doses in total) of native E. coli L-asparaginase.

Conclusion This desensitization protocol was safe and allows continued administration of native E. coli L-asparaginase administration.

Departments of *Pediatric Hematology

Pediatrics, Yüzüncü Yil University Faculty of Medicines, Van Turkey

Reprints: Sinan Akbayram, MD, Department of Pediatrics, Yüzüncü Yil University Faculty of Medicines, 65200 Van, Turkey (e-mail:

Received for publication September 4, 2009; accepted March 2, 2010

© 2010 Lippincott Williams & Wilkins, Inc.