Prevention of Subsequent L-Asparaginase Hypersensitivity in Children Through Premedication: A Single-Center Experience.

OBJECTIVE: L-asparaginase. METHODS: A retrospective cohort study was conducted in 119 children with ALL treated with L-asparaginase at Chiang Mai University Hospital. Ten patients (8.4%) developed severe systemic hypersensitivity reactions. Subsequent intramuscular L-asparaginase doses were preceded by a standardized premedication protocol comprising oral prednisolone, cetirizine, and montelukast, along with preinfusion intravenous hydrocortisone. RESULTS: A total of 76 subsequent L-asparaginase doses were administered following premedication. Seven episodes (9.2%) of recurrent hypersensitivity reactions occurring within 5 to 40 minutes of L-asparaginase dosing occurred in 6 patients. Most reactions were mild and managed with additional antihistamines and corticosteroids. One episode required treatment with intramuscular epinephrine. All patients successfully completed their prescribed course of L-asparaginase therapy. CONCLUSION: L-asparaginase therapy in children with a history of severe hypersensitivity reactions, thus potentially improving access to chemotherapy treatment.