Medication contaminants as a potential cause of anaphylaxis to vincristine

Abstract

Vincristine (VCR) is a vinca alkaloid and common chemotherapeutic that is used to treat multiple pediatric and adult malignancies. Despite its common use, cases of anaphylaxis to VCR are rare and typically isolated to a single individual. We report a series of eight patients with adverse reactions to VCR over the course of 11 months at a single institution, four of which progressed to anaphylaxis and one of which resulted in cardiac arrest. Mass spectrometry analysis of medication lots was concerning for possible contaminant. Our findings highlight the risk of anaphylaxis during therapy with VCR.

Neither iatrogenic nor hereditary cause: A rare case of anaphylaxis to low sorb tubing used for infusions

“…Root cause analysis was done, since anaphylaxis to vincristine is exceedingly rare 1–3 . In the following 2 weeks, the patient had two additional anaphylactic reactions, one while receiving IV pentamidine and one while receiving premedication with IV hydrocortisone, indicating that anaphylaxis was not due to vincristine.…”

Medication contaminants as a potential cause of anaphylaxis to vincristine: What about drug‐specific antigens?

“…We have read with interest the report published in Pediatric Blood Cancer concerning five male and three female patients, with an average age of 5 years, who developed symptoms including respiratory problem, vomiting, flushing without hives, hypotension, mouth itch, headache, or cardiac arrest during or immediately after intravenous vincristine infusion. Mass spectrometry identified three molecules, two of which were likely related to the vinca alkaloids but the third was not related to them.…”

“…Furthermore, corticosteroids, drugs used to treat allergy, paradoxically can also induce anaphylactic reactions . Indeed, in the report of Hill et al . four of their patients had received premedications (antihistamines ± steroids) prior to subsequent infusions.…”

Reply to: Medication contaminants as a potential cause of anaphylaxis to vincristine: What about drug specific antigens?

“…We appreciate the informative letter by Dr. Nicholas Kounis and colleagues in response to our manuscript entitled “Medication contaminants as a potential cause of anaphylaxis to vincristine.” Kounis et al. propose some questions about our report and discuss it broadly in the context of drug allergy .…”