Doxorubicin-associated flare reactions

An analysis was made of 539 cases of venous flare reactions associated with the administration of doxorubicin. These reactions always were nondebilitating and generally were transient with complete resolution occurring within 45 minutes of onset in 462 patients (86%). Local urticaria occurred in 133 patients (25%), and 35 patients (6%) reported either vein pain or a stinging sensation. In 20 cases (4%), erythema in the region immediately surrounding the infusion site accompanied the primary manifestation of erythema along the course of the vein proximal to the infusion site. The incidence of initial flare reactions peaked in the autumn months. These reactions frequently occurred at clinical sites in sporadic clusters. Clinical features are described that differentiate flare reactions from early extravasations of doxorubicin. Procedures for minimizing the possibility of the occurrence or reappearance of flare reactions are suggested.