Management of hypersensitivity reactions: a nursing perspective

Infusion reactions occur commonly with the administration of monoclonal antibody therapy and can vary in severity. Oncology nurses have experience in hypersensitivity reactions with different chemotherapy agents, but with the increased use of monoclonal antibody therapy in the treatment of various cancers, knowledge of specific risk and management of reactions with these therapies is important. Anaphylactic reactions are mediated by IgE and anaphylactoid reactions are not; monoclonal antibody reactions are also considered to be associated with cytokine release syndrome, which has a specific constellation of symptoms associated with it. Infusion reactions, while common, have the potential to be distressing and frightening to oncology nurses. These challenging occurrences also can increase hospitalization costs. Strategies to manage reactions have included patient desensitization, alteration of infusion rates, skin testing, and the use of premedication. Baseline comprehensive assessments, including allergy history, are important in reducing or preventing hypersensitivity reactions. Clinical pathways or established guidelines can help to familiarize staff with appropriate responses to infusion reactions and nurses should be aware of the variety of symptoms which can indicate infusion or hypersensitivity reactions. Oncology nurses should understand the management of hypersensitivity and anaphylaxis; the Oncology Nursing Society and the American Heart Association have both published guidelines to assist practicing health-care professionals with the management of this potentially fatal adverse event. Knowledge of emergency drugs and mechanism of action is vital. Nurses should be aware of appropriate emergency response as well as management of delayed or biphasic hypersensitivity reactions. Oncology nurses should be well-prepared for these often common events.