Risk Of Hypersensitivity Reactions Research Articles

Intravenous injection versus transhepatic intracholecystic injection of indocyanine green (ICG) to outline biliary tree during laparoscopic cholecystectomy

BackgroundTo potentially lessen injuries and associated complications, fluorescence cholangiography has been suggested as a technique for enhancing the visualization and identification of extrahepatic biliary anatomy. The most popular way to administer indocyanine green (ICG) is intravenously, as there is currently little data on ICG injections directly into the gallbladder. In order to visualize extrahepatic biliary anatomy during laparoscopic cholecystectomy (LC), we compared the two different ICG administration techniques. We also examined variations in visualization time, as well as the effectiveness, benefits, and drawbacks of each modality.MethodsIn this prospective randomized clinical study, 60 consecutive adult patients with chronic and acute gallbladder disease were included. Our study conducted from 2022 to 2024 in Surgical Department of Theodor Bilharz Research Institute. Thirty patients underwent LC with intravenous ICG administration (IV-ICG), thirty patients received a direct injection of gallbladder through transhepatic ICG (IC-ICG) and Preoperative, intraoperative, and postoperative patient data were examined.ResultsIn terms of their perioperative and demographic features, the groups were similar. Without a statistically significant difference, the IV-ICG group’s total operating time was less than that of the IC-ICG group (p 0.140). Compared to the transhepatic IC-ICG method, IV-ICG was more accurate in identifying the duodenum and the common hepatic duct (p = 0.029 and p = 0.016, respectively). In the transhepatic IC-ICG and IV-ICG groups, the cystic duct could be identified prior to dissection in 66.6% and 73.3% of cases, respectively, and this increased to 86.6% and 93.3% following dissection. In the transhepatic IC-ICG group, the common bile duct was visible in 93.3% of cases; in the IV-ICG group, it was visible in 90% of cases. Two cases in the IC-ICG group and every case following IV-ICG administration had liver fluorescence (6.6% versus 100%; p < 0.001).ConclusionThe current study shows that for both administration methods, ICG-fluorescence cholangiography can be useful in identifying the extrahepatic biliary anatomy during Calot’s triangle dissection. By avoiding hepatic fluorescence, the transhepatic IC-ICG route can increase the bile duct-to-liver contrast with less expense and no risk of hypersensitivity reactions than the intravenous ICG injection method. We recommend to use both techniques in case of acute cholecystitis with cystic duct obstruction. In cases of liver cirrhosis, we recommend transhepatic IC-ICG as IV-ICG is limited.

Oxaliplatin triggered hypersensitivity reactions in colorectal cancer patients: Case report

Colorectal cancer stands as a significant global health concern, encompassing adenocarcinoma of both the colon and rectum. Recognized risk factors include advancing age and medical history of inflammatory bowel conditions like Crohn's disease or ulcerative colitis. Oxaliplatin, a platinum-based chemotherapy agent, serves as the frontline treatment for colorectal cancer due to its cytotoxic effects on cancerous cells. However, its use is not without complications, as hypersensitivity reactions can occur, posing challenges in patient management. This case report discusses two instances where patients undergoing chemotherapy for colorectal cancer developed grade two hypersensitivity reactions following oxaliplatin administration, the Naranjo probability scale was used to analyze the causation of the adverse drug reactions (ADRs), and a score of 6 was obtained, indicating oxaliplatin as a probable cause of the hypersensitivity reactions. In both cases, treatment was promptly halted upon manifestation of symptoms, and patients were administered intravenous steroids along with anti-histamines. This intervention resulted in significant improvement in the patients' conditions. Both genders are equally susceptible to such reactions, emphasizing the need for gender-neutral awareness and precautionary measures among medical practitioners. This case report serves as a reminder of the potential adverse effects associated with oxaliplatin therapy in colorectal cancer patients. Heightened awareness among healthcare professionals regarding the risk of hypersensitivity reactions is imperative to ensure timely detection and appropriate management, thereby optimizing patient outcomes. Consequently, while giving oxaliplatin to cancer patients, healthcare professionals need to use extreme caution.

Management of Patients with Hypersensitivity to Platinum Salts and Taxane in Gynecological Cancers: A Cross-Sectional Study by the European Network of Young Gynaecologic Oncologists (ENYGO).

Platinum and taxane chemotherapy is associated with the risk of hypersensitivity reactions (HSRs), which may require switching to less effective treatments. Desensitization to platinum and taxane HSRs can be used to complete chemotherapy according to the standard regimen. Therefore, we aimed to investigate the current management of HSRs to platinum and/or taxane chemotherapy in patients with gynecologic cancers. We conducted an online cross-sectional survey among gynecological and medical oncologists consisting of 33 questions. A total of 144 respondents completed the survey, and 133 respondents were included in the final analysis. Most participants were gynecologic oncologists (43.6%) and medical oncologists (33.8%), and 77.4% (n = 103) were involved in chemotherapy treatment. More than 73% of participants experienced >5 HSRs to platinum and taxane per year. Premedication and a new attempt with platinum or taxane chemotherapy were used in 84.8% and 92.5% of Grade 1-2 HSRs to platinum and taxane, respectively. In contrast, desensitization was used in 49.4% and 41.8% of Grade 3-4 HSRs to platinum and taxane, respectively. Most participants strongly emphasized the need to standardize the management of platinum and taxane HSRs in gynecologic cancer. Our study showed that HSRs in gynecologic cancer are common, but management is variable and the use of desensitization is low. In addition, the need for guidance on the management of platinum- and taxane-induced HSRs in gynecologic cancer was highlighted.

Recent Progress on Microtubule Degradation Agents.

Targeted protein degradation (TPD) has emerged as the most promising approach for the specific knockdown of disease-associated proteins and is achieved by exploiting the cellular quality control machinery. TPD technologies are highly advantageous in overcoming drug resistance as they degrade the whole target protein. Microtubules play important roles in many cellular processes and are among the oldest and most well-established targets for tumor chemotherapy. However, the development of drug resistance, risk of hypersensitivity reactions, and intolerable toxicities severely restrict the clinical applications of microtubule-targeting agents (MTAs). Microtubule degradation agents (MDgAs) operate via completely different mechanisms compared with traditional MTAs and are capable of overcoming drug resistance. The emergence of MDgAs has expanded the scope of TPD and provided new avenues for the discovery of tubulin-targeted drugs. Herein, we summarized the development of MDgAs, and discussed their degradation mechanisms, mechanisms of action on the binding sites, potential opportunities, and challenges.

Reducing unnecessary premedication prior to parenteral iron therapy: A quality improvement project.

Intravenous (IV) iron carries risks of mild, self-limiting, tryptase-negative Fishbane and complement activation-related pseudo-allergy reactions, with rare reports of anaphylaxis. Historically, high-molecular-weight iron dextran (HMWID) was associated with a higher incidence of anaphylaxis and empiric premedication with antihistamines/corticosteroids have been used to mitigate this risk. HMWID is no longer available and the risk of hypersensitivity reactions with newer IV iron formulations is low. Therefore, the use of routine prophylactic premedication in all patients is not justified but should be considered in high-risk patients. Our primary aim was to reduce inappropriate premedication before IV iron administration by 50% so that our institution's hematology providers only prescribe premedications to patients at high risk of having a severe reaction. Interventions included a multidisciplinary education initiative to highlight current evidence against universal administration of premedications and revision of the IV iron informed consent form and electronic order set. We measured the success of our intervention by comparing data collected during a 6-month pre-intervention period (837 infusions) to a 6-month post-intervention period (947 infusions). Inappropriate administration of premedications decreased from 79% in the pre-intervention period compared to 65% in the post-intervention period. We found no significant difference in the number of Fishbane reactions, severe reactions, and emergency room admissions, despite this reduction in premedication use. Although we did not reach our goal of a 50% reduction in inappropriate premedication use, opportunities for process improvements were uncovered and are being explored in the next cycle of this quality improvement project.

P70-2 A study of carboplatin-related hypersensitivity reactions in our hospital

Carboplatin is used for many types of cancer, sometimes at very high dosing rates. It has been reported that the risk of hypersensitivity reactions (HSRs) increases as the frequency of carboplatin administration increases, but the relationship between frequency of administration and risk is not clear. We investigated the relationship between the number of times carboplatin was administered to cancer patients and the frequency of HSRs in our hospital. We also investigated the frequency of HSRs to other platinum drugs in patients who had developed HSRs.

Efficacy and Adverse Events of Carboplatin Desensitisation Therapy for Gynaecological Cancer: A Retrospective Study.

Background: Carboplatin, the key drug used in treating gynaecological cancer, has an approximately 12–16% risk of hypersensitivity reactions. We aimed to investigate the efficacy and adverse effects of carboplatin desensitisation therapy for gynaecological cancer. Methods: The desensitisation protocol was standardised as a four-step, 4-h, carboplatin administration in the hospital. A retrospective medical record review was conducted on 15 patients who underwent carboplatin desensitisation for gynaecological malignancies at our hospital. Patients’ data were analysed to evaluate the treatment success rate, therapeutic effect of desensitisation, adverse events, and treatment. Results: Of 91 carboplatin desensitisation cycles scheduled; the completion rate was 93.4% (85/91). Adverse events occurred in 23 of these 91 (25.3%). In four (4.4%) of the 23 cycles, hypersensitivity reactions could be treated only by discontinuing the infusion and slowing the administration, while in the remaining 19 (20.9%), medication was administered intravenously after discontinuing the infusion to manage hypersensitivity reactions. No treatment-related deaths occurred. Overall, 23 series of anti-cancer agent regimens, including carboplatin desensitisation, were administered to the 15 patients. The therapeutic response rate was 82.6% and the disease control rate was 95.7%. Conclusions: Carboplatin desensitisation was beneficial in patients with a history of carboplatin-induced hypersensitivity reactions.

Pegaspargase: Two Pediatric Case Studies of Delayed Urticaria Preceding Anaphylactic Reactions Postadministration.

Pegaspargase, a chemotherapy drug known to improve survival outcomes in acute lymphoblastic leukemia, is associated with a risk for hypersensitivity reactions. At a children's hospital in the midwestern United States, two patients developed unusual reactions consisting of disseminated urticaria about two weeks after their second dose of pegaspargase. Both patients then proceeded to have severe anaphylaxis with the third dose of pegaspargase. These cases highlight the importance of advanced practice nurses being alert for the occurrence of unusual and delayed reactions to chemotherapy administration.

Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Quinolones.

The consumption of quinolones as first-line treatment has increased in recent years, leading to an increase in the incidence of hypersensitivity reactions (HSRs) to this antibiotic group. Both diagnosis and management of HSRs to quinolones are complex and controversial. These practical guidelines aim to provide recommendations for effective clinical practice. The recommendations were drafted by an expert panel that reviewed the literature regarding HSRs to quinolones and analyzed controversies in this area. Most HSRs to quinolones are immediate and severe. The risk for HSRs is higher in patients who report allergy to ß-lactams, moxifloxacininduced anaphylaxis, and immediate reactions than in patients who report reactions to quinolones inducing other symptoms. The usefulness of skin tests in diagnosing HSRs to quinolones is controversial, with sensitivity and specificity varying between studies. Most in vitro tests are produced in-house, with no validated commercial options. The basophil activation test has proven useful for diagnosing immediate reactions, albeit with diverse results regarding sensitivity. Drug provocation testing is currently the gold standard for confirming or excluding the diagnosis and for finding safe alternatives, although it is contraindicated in patients with severe reactions. Cross-reactivity between quinolones has proven controversial in several studies, with the lowest cross-reactivity reported for levofloxacin. Desensitization may be considered in allergy to quinolones when no other alternatives are available.

ANALYSIS OF COMPLICATIONS INDUCED BY IODINE-BASED RADIOGRAPHIC CONTRAST MEDIA AND OF METHODS OF THEIR PREVENTION (A literature review)

&#x0D; &#x0D; &#x0D; The existence of modern medical practice is impossible without the use of radiological diagnostic methods. Due to the introduction of evidence-based medicine, most diagnoses need to be confirmed by imaging techniques, and some diseases require radiographic contrast media. Despite the medical and scientific break- through in these technologies, there are still risks of developing an individual body reaction to the contrast agent. In view of this, the purpose of the work was to substantiate the choice of iodine-containing radiographic contrast agents, to study the possible complications caused by these substances during the X-ray examination, and the methods of prevention of such conditions. To determine these key points, an analytical review of the literature was conducted. Analysis of iodine-containing radiographic contrast agents, which differ in their chemical structure and prop- erties, showed the advantage of non-ionic radiographic contrast media over the ionized ones. The work considers hypersensitive reactions and thyroid dysfunctions caused by the introduction of iodine-containing contrast agents. The allergic reactions may occur occur regardless of the dose of the drug, immediately or after some time after the examination. Due to the fact that the average duration of radiographic examination is from a few minutes to an hour, the appearance a certain reaction to iodine-containing radiographic contrast agents in a patient may not be established in time. That is why, it important to monitor a patient in the radiology department for 30 minutes after the examination. When establishing an increased risk of hypersensitivity reactions, due to the collection of anamnesis, it is necessary to carry out premedication with glucocorticoids is recommended according to the scheme that is described in the literature and is used in the modern medical practice. The development of hyperthyroidism or hypothyroidism depends on the initial level of hormones and the correct operation of the response system. In the presence of anamnestic and laboratory risk factors that can cause the occurrence of these conditions (TSH, free T4, total T3 and Thyroid peroxidase antibodies), it is recommended to consult an endocrinologist and, based on his/her judgement, to carry out premedication with the control of the TSH levels according to the schemes presented in the literature review or, alternatively, to correct the existing pathological conditions before the examination.&#x0D; &#x0D; &#x0D;

Clinical Characterization and Diagnostic Approaches for Patients Reporting Hypersensitivity Reactions to Quinolones

Quinolones are the second most frequent cause of hypersensitivity reactions (HSRs) to antibiotics. A marked increase in the number of patients with HSRs to quinolones has been detected. To describe the clinical characteristics of patients with HSRs to quinolones and present methods for their diagnosis. Patients attending the allergy unit due to reactions suggestive of HSRs to quinolones were prospectively evaluated between 2005 and 2018. Diagnosis was achieved using clinical history, skin tests (STs), basophil activation tests (BATs), and drug provocation tests (DPTs) if ST and BAT results were negative. We included 128 subjects confirmed as having HSRs to quinolones and 42 found to be tolerant. Anaphylaxis was the most frequent entity in immediate HSRs and was most commonly induced by moxifloxacin. Patients were evaluated a median of 150 days (interquartile range, 60-365 days) after the reaction. Of patients who underwent ST and BAT, 40.7% and 70%, respectively, were positive. DPT with a quinolone was performed in 48 cases, giving results depending on the culprit drug: when moxifloxacin was involved, 62.5% of patients gave a positive DPT result to ciprofloxacin, whereas none reacted to levofloxacin. The risk of HSR was 96 times higher in subjects who reported moxifloxacin-induced anaphylaxis and 18 times higher in those reporting immediate reactions compared with clinical entities induced by quinolones other than moxifloxacin and nonimmediate reactions. The diagnosis of HSR to quinolones is complex. The use of clinical history is essential as a first step. BAT shows higher sensitivity than STs. DPTs can be useful for finding safe alternative quinolones.

Evaluation of the reported rates of hypersensitivity reactions associated with iron dextran and ferric carboxymaltose based on global data from VigiBase™ and IQVIA™ MIDAS® over a ten-year period from 2008 to 2017

ABSTRACT Objectives It is hypothesized that the risk of hypersensitivity reactions (HSRs) may be lower with ferric carboxymaltose than iron dextran because of its non-dextran carbohydrate moiety. This study compares the risk of HSRs between iron dextran and ferric carboxymaltose. Methods This was a retrospective pharmacoepidemiological study with a case–population design covering 2008–2017. Global exposure data were estimated using IQVIA™ sales data. Spontaneously reported HSR data were retrieved from the World Health Organization database (VigiBase™) using different search criteria including: the Standardized MedDRA® Query (SMQ) ‘Anaphylactic reaction’; type I–IV HSR terms; narrow terms for anaphylactic/anaphylactoid reactions; and cases with a fatal outcome. Results Total exposure in 100 mg doses was 117.3 million for iron dextran and 84.2 million for ferric carboxymaltose. The relative risk (with 95% confidence interval) for ferric carboxymaltose versus iron dextran was 4.18 (3.88–4.50) for SMQ Anaphylactic reaction; 12.9 (9.90–16.7) for type I–IV HSRs; 1.72 (1.45–2.04) for anaphylactic/anaphylactoid reactions; and 1.92 (1.24–2.99) for death. Conclusion The risk of spontaneously reported HSRs was consistently higher with ferric carboxy-maltose than with iron dextran over the period 2008–2017. Thus, this study does not support that dextran-free intravenous irons are associated with fewer HSRs than iron dextran.

PF177 NATION‐WIDE PROSPECTIVE, REAL‐TIME MONITORING OF PEGYLATED E.COLI AND ERWINIA ASPARAGINASE THERAPY IN CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA AND NON‐HODGKIN LYMPHOMA IN BELGIUM

Background:Asparaginase (ASNase) is an important anti‐leukemic drug in the treatment of childhood acute lymphoblastic leukemia (ALL) and non‐Hodgkin lymphoma (NHL). Depletion of asparagine by ASNase results in selective apoptosis of lymphoblasts which depend on an external source of asparagine for their cell growth. A substantial proportion of patients develops anti‐ASNase neutralising antibodies, resulting in allergic reactions or silent inactivation (SI), characterized by rapid clearance and inactivation of ASNase.Aims:Prospective, real‐time therapeutic drug monitoring of peg‐ASNase (Oncaspar®) and Erwinia ASNase (Erwinase®) in children treated for ALL and NHL in Belgium.Methods:Patients (1‐18y) with newly diagnosed ALL and precursor B‐ or T‐lymphoblastic NHL from 8 Belgian pediatric hemato‐oncology centres were enrolled between 01/2013 and 11/2017. All patients were treated according to the treatment guidelines of the EORTC‐CLG 58081 study. ASNase activity was quantified using the AHA test (described by Lanvers et al., 2002) using a SpectraMax M3 spectrophotometer (Molecular Devices). ASNase activity &gt;100U/L was considered to be sufficient for complete depletion of asparagine. Erwinia ASNase was given as second line after allergic reaction or silent inactivation to Peg‐ASNase. One dose of Peg‐ASNase 2,500IU/m2 was replaced by 6 doses of 20,000U/m2 Erwinia ASNase in 2 weeks.Results:In total, 286 children (118 girls and 168 boys) with newly diagnosed ALL (n = 260) and NHL (n = 26) were enrolled in the prospective real‐time ASNase monitoring programme.Clinical allergic reactions were seen in 33 (11.5%), and silent inactivation in 14 (4.9%) patients treated with peg‐ASNase. Most allergies were CTCAE 4.03 grade 2‐3 and occurred after the second or third administration. SI was mainly seen after the second administration and in maintenance therapy. Patients were more at risk for hypersensitivity reactions after an ASNase‐free period. Forty‐two of them were switched to Erwinia ASNase. Three patients (7.1%) experienced a clinical allergic reaction, and 1 (2.4%) a silent inactivation on Erwinia ASNase.Median ASNase activity after the first peg‐ASNase was 1254U/L (range:704‐2027U/L) one hour after administration (peak), 921U/L (147–1727U/L) at day 7 (D7) and 574U/L (&lt;5–1807U/L) at day 14 (D14). After the second administration in induction, patients reached higher median activity levels 2091U/L (&lt;5–5208U/L) (peak), 1181U/L (&lt;5–2107U/L) at D7 and 666U/L (&lt;5–1151U/L) at D14. After peg‐ASNase in re‐induction, median ASNase activity was 1916U/L (&lt;5–13255U/L) (peak), 1358U/L (&lt;5–5621U/L) at D7 and 802U/L (&lt;5–3346U/L) at D14.Median Erwinia ASNase activity 2 days after administration (D2) was 321U/L (14–1195U/L) and 76U/L (&lt;5–529U/L) at day 3 (D3), with significantly more D3‐samples &lt;100U/L (62.5% vs 10%, P = &lt;0,001). According to the route of administration, median activity at D2 was significantly higher for intramuscularly (IM) Erwinia administrations (358U/L, [19–1195U/L]) than for intravenous (IV) administrations (159U/L, [14–1097U/L]). 61.5% IV‐treated patients and 90.5% IM‐treated patients achieved an activity above 100U/L in ≥75% of the D2 samples.Summary/Conclusion:This prospective nation‐wide, multi‐center study shows that monitoring of ASNase activity during treatment of children with ALL and NHL is feasible and informative. Allergy and SI occurred after both peg‐ASNase and Erwinia ASNase administration.Treatment with Erwinia ASNase warrants close monitoring of activity levels and optimally, adherence to a two‐day interval of IM administrations.

Oxaliplatin: Detection and Management of Hypersensitivity Reactions.

Oxaliplatin is used extensively for the treatment of gastrointestinal cancer and other malignancies, with increased frequency of use in recent years. Hypersensitivity reactions (HSRs) can pose a major problem in clinical practice because they can limit the use of oxaliplatin in the care of malignancies in which it has proven efficacy. Nurses play an integral role in the administration of oxaliplatin; therefore, they need to be well educated in the prevention, detection, and management of HSRs. This article reviews the symptoms of HSRs associated with oxaliplatin, the specific management of HSRs associated with oxaliplatin, the role of desensitization, and the potential use of skin testing to better identify patients at risk for HSR. This article reviews the literature related to the diagnosis, prevention, and management of HSRs associated with oxaliplatin and outlines nurses' role. Oxaliplatin HSRs can occur at any cycle, but patients are at highest risk after they have received six prior infusions of oxaliplatin.

OCTREOTIDE SKIN TESTING: A FALSE POSITIVE

Introduction Allergic reactions to octreotide are rarely reported in the literature and nonirritating skin testing concentrations have not been established. We present a patient with false-positive skin testing to octreotide. Case Description The patient is a 67 year old female with a pancreatic neuroendocrine tumor who was started on octreotide for control of symptoms related to elevated gastrin secretion. For her first octreotide treatment, patient received 100 mcg subcutaneously. Within ten minutes, patient developed redness at the site of injection and complaints of feeling hot with subsequent development of facial flushing, scalp and ear erythema and epigastric pain. Patient reported that six hours later she developed severe abdominal pain, reflux and bloating. Octreotide skin testing, including prick testing (SPT) and intradermal (ID), was performed. SPT at 50mcg/mL was negative and ID was negative at 0.5 mcg/mL and positive at 5 mcg/mL on patient. ID was repeated on 4 controls at 5 mcg/mL with 2 positive and 2 negative results. The patient underwent a three step graded challenge and subsequently continued monthly doses without further reaction. Discussion Octreotide skin testing has been reported as useful (up to 5 mcg/mL). This case demonstrates that ID octreotide skin testing at 5 mcg/mL can be falsely positive as we had both positive and negative results on control subjects. This highlights the importance of careful clinical history gathering when evaluating patients with drug allergy. Graded challenge is a useful procedure for patients with history of drug allergy, inconclusive skin testing results and low risk of hypersensitivity reaction.

Safety and Tolerability of Combinations of Empagliflozin and Linagliptin in Patients with Type 2 Diabetes: Pooled Data from Two Randomized Controlled Trials.

Two 52-week Phase III studies evaluated the efficacy and safety of once-daily combinations of empagliflozin/linagliptin as monotherapy or add-on to metformin in patients with type 2 diabetes (T2DM). The aim of this analysis was to further assess the safety and tolerability of empagliflozin/linagliptin compared with their individual components in patients with T2DM, using pooled data from these trials. A total of 1363 patients were treated with empagliflozin 25mg/linagliptin 5mg (n = 273), empagliflozin 10mg/linagliptin 5mg (n = 272), empagliflozin 25mg (n = 276), empagliflozin 10mg (n = 275), or linagliptin 5mg (n = 267). Adverse events (AEs) were assessed descriptively in patients who took ≥ 1 dose of study drug. Total exposure was 251, 255, 256, 249, and 243 patient-years in the empagliflozin 25mg/linagliptin 5mg, empagliflozin 10mg/linagliptin 5mg, empagliflozin 25mg, empagliflozin 10mg, and linagliptin 5mg groups, respectively. The proportion of patients with ≥ 1 AE was similar across groups (70.4-74.9%). The percentage of patients with confirmed hypoglycemic AEs (plasma glucose ≤ 70mg/dL and/or requiring assistance) was low in all groups (1.1-2.2%); none required assistance. Events consistent with urinary tract infection were reported in similar percentages of patients in all groups (11.4-13.8%), and in a greater proportion of female than male patients. Events consistent with genital infection were reported in higher percentages of patients on empagliflozin/linagliptin or empagliflozin (4.0-6.5%) than linagliptin 5mg (2.6%), and in a greater proportion of females than males. The risks of hypersensitivity reactions and events consistent with volume depletion were low across treatment groups. Empagliflozin/linagliptin as monotherapy or add-on to metformin for 52weeks was well tolerated in patients with T2DM, with safety profiles similar to individual components, including a low risk of hypoglycemia. The Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance. ClinicalTrials.gov identifiers, NCT01422876 & NCT01422876.

Liposomal Irinotecan: Nursing Considerations in an Outpatient Cancer Center

Recent approaches in treating pancreatic adenocarcinoma, an aggressive disease with limited survival, include the use of liposomal irinotecan as an option when first-line therapy has failed. Liposomal irinotecan has been approved in combination with 5-fluorouracil and leucovorin for patients with metastatic pancreatic cancer. Liposomal irinotecan is a newer therapy requiring oncology nurses to obtain knowledge and skills for proper administrating, monitoring of hypersensitivity reactions during infusion, managing side effects, and providing patient education. Nursing considerations when administering this drug include infusion time, premedication, risk for hypersensitivity reactions and adverse events, and side effects.

Hypersensitivity to Carboplatin in Children with Malignancy.

Purpose: Carboplatin-based regimens have proven efficacy in children with cancer. However, the development of hypersensitivity reactions (HSRs) may have a negative impact on treatment intensity and patients’ outcome. The aim of this review is to summarize the incidence and the clinical features of HSRs occurring in children with cancer treated with carboplatin and their impact on treatment efficacy.Methods: Data were collected by searching for relevant studies on the incidence, clinical features and management of possible side effects about the use of carboplatin in children, published from March 1987 to October 2016 in the PubMed database.Results: Carboplatin HSRs present with mild/moderate to severe clinical patterns. The risk of HSR is related to the cumulative number of infusions. Moreover, a greater risk of developing an HSR has been observed in younger patients than in older age groups of children; risk is also greater in girls and in patients with a prior history of allergy to other drugs. Management options include cessation of carboplatin and switching to another agent, premedication with antihistamines and/or corticosteroids, and carboplatin desensitization. For sensitized patients who have obtained benefits from carboplatin, the continuation of the treatment is desirable and desensitization protocols have showed promising results.Conclusion: Clinicians must not underestimate the potential risk and occurrence of carboplatin HSRs in the pediatric population in order to outline adequate management strategies. Desensitization protocols should be considered for patients sensitive to carboplatin in order to avoid having to discontinue an effective chemotherapy.

Self-Administered Premedication: Improving Taxane Chemotherapy Treatment .

Patients receiving taxane therapy are at risk for hypersensitivity reactions without appropriate premedication management. Patients must understand the importance of taking premedications as prescribed to prevent reactions. . The objectives of this study were to implement and evaluate a multidisciplinary practice protocol comprised of standardized nursing documentation of premedication regimens, teaching, and patient adherence to at-home premedication in an electronic health record (EHR). . A new process was developed to provide standardized prescriptions, a personalized instruction sheet for patients and families, and a standardized approach to document adherence and teaching in the EHR. Pre- and post-EHR audits were used twice to evaluate the practice changes. . The findings of the first audit suggested improvement in all practice changes. After the first audit, reinforcement of the changes occurred within the group and with one-on-one meetings. The goal of 90% adherence was met at the second audit.

Carbon Dioxide as Contrast Medium to Guide Endovascular Aortic Aneurysm Repair

Iodine contrast medium (ICM) is considered to be gold standard in endovascular procedures, but its nephrotoxicity and hypersensitivity limit the widespread use. Carbon dioxide (CO2) is considered as an alternative for endovascular procedures in patients with contraindication to ICM. However, no studies have compared the outcomes of endovascular aneurysm repair (EVAR) performed with ICM or CO2 among patients with no contraindication to ICM. From May 2012 to April 2014, 36 patients with abdominal aortic aneurysms underwent EVAR in a prospective, randomized, and controlled study. Patients were randomized into 2 groups, CO2 or ICM group. We were able to perform the proposed procedures in all patients in this study. There were no conversions to open surgery and no CO2-related complications. Endovascular material costs, duration of surgery, and time of fluoroscopy were similar between groups, and the cost of the contrast media was smaller in the CO2 group than in the ICM group. Among CO2 group procedures, 62.5% of the patients needed ICM complementary use. The use of CO2 as a contrast medium for EVAR is an alternative in patients with no restriction for ICM, with similar outcomes when compared to ICM, regarding duration of surgery, duration of fluoroscopy, and endovascular material costs. Using CO2, there were no changes in creatinine clearance and no risk of hypersensitivity reactions; moreover, there was a reduction in contrast-related costs for EVAR procedures. However, in our study, additional use of ICM to visualize the internal iliac artery was needed in most procedures.