Allergic Reaction to Escherichia Coli-Asparaginase in Childhood Acute Lymphoblastic Leukemia: A Study in a Tertiary Hospital in Indonesia

Abstract

Objective: The objective of the study was to determine and describe the characteristics of allergic reactions to Escherichia coli-Asparaginase (E. coli-ASP).
 Methods: This cross-sectional study was performed at Hasan Sadikin Bandung General Hospital on acute lymphoblastic leukemia patients diagnosed from January 1, 2018, to August 31, 2019, confirmed by bone marrow examination. Data were extracted from Bandung Online Pediatric Cancer Registry, medical records, protocol therapy documents, and interview with patient’s guardian.
 Results: Out of 68 patients, 26 patients (37.6%) were allergic to E. coli-ASP. Twenty-two patients with recorded manifestation’s data evoked 35 symptoms and graded according to common terminology criteria for adverse event v3.0., fever, and urticaria are the most frequent manifestation. While Grade 2 and Grade 3 are the most often developed allergic reaction, patients with age range from 1 to 14 years, male and high risk is mainly allergic.
 Conclusion: Allergic rate to E. coli-ASP at Hasan Sadikin General Hospital is 37.6%. The most frequent manifestation is fever and urticaria (20%, respectively), Grades 2 and 3 (32%, respectively), and emerged mostly after administration of fourth dose E. coli-ASP (26.9%). Despite the characteristic differences between allergic and non-allergic group, it is not statistically significant.

Allergic Reactions to E. coli Asparaginase are Associated with Decreased Asparaginase Activity in an Indonesian Pediatric Population with ALL

“…It is of note that a patient could experience two manifestations at once. These findings are consistent with previous studies in RSHS which found urticaria to be the most common manifestation (Sari et al, 2020). The most common onset of allergic manifestations was at the 5 th dose, with a total of 6-8 doses of ASP being given.…”

“…The immunological side-effects of ASP can be classified as type 1 hypersensitivity reactions (allergies) and the formation of neutralizing antibodies which can reduce ASP activity (Woo et al, 2000;Hijiya and Sluis, 2016;Sluis et al, 2016). The allergy frequency in this study was 32.4% in line with previous RSHS data for 2018-2019, with a reported allergy frequency of 37.6% (Sari et al, 2020). Other studies using different protocols reported that the incidence of ASP allergy varies widely, ranging between 10-60% (Panosyan et al, 2004;Liu et al, 2012) due to differences in formulation, route, and dose of administration (Szewczyk et al, 2004).…”

Desenvolvimento e caracterização de lipossomas peguilados para veiculação de L-asparaginase

“…Apesar dos protocolos existentes, a maior limitação do uso das ASNase são as reações de hipersensibilidade e conseguinte formação de anticorpos anti-asparaginase o que diminui a atividade enzimática. As reações imunes causadas por ASNase relatadas por estudos são segmentadas em hipersensibilidade clínica, com reações alérgicas que podem partir de eritema local, anafilaxia e hipersensibilidade subclínica (BATTISTEL et al, 2020;SARI;OSSEVA;SURYAWAN, 2020), o risco dessas reações pode aumentar com a reexposição à enzima na fase de pós-indução (BATTISTEL et al, 2020).…”