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Prevention of Subsequent L-Asparaginase Hypersensitivity in Children Through Premedication: A Single-Center

Pongsathorn Saligupta1, Chane Choed-Amphai1, Lalita Sathitsamitphong1

  • 1Division of Allergy and Clinical Immunology (PS, ML), Division of Pediatric Hematology and Oncology (CC, LS), Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.

The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
|February 12, 2026
PubMed

Insights

A premedication protocol safely enabled continued L-asparaginase therapy for children with ALL who experienced severe hypersensitivity reactions. This approach improves chemotherapy access in resource-limited settings.

Area of Science:

  • Pediatric Oncology
  • Pharmacology
  • Clinical Immunology

Background:

  • L-asparaginase is crucial for treating pediatric acute lymphoblastic leukemia (ALL).
  • Hypersensitivity reactions to L-asparaginase necessitate alternative treatments, which may be unavailable in resource-limited areas.
  • Native *Escherichia coli* L-asparaginase is a common formulation, but severe reactions can occur.

Purpose of the Study:

  • To assess the safety and feasibility of a premedication protocol.
  • To prevent hypersensitivity reactions in children with a history of severe reactions to native *E. coli* L-asparaginase.
  • To enable continued L-asparaginase therapy in resource-limited settings.

Main Methods:

  • Retrospective cohort study of 119 children with ALL.
  • Identified 10 patients (8.4%) with severe systemic hypersensitivity reactions.
  • Administered a premedication protocol including oral prednisolone, cetirizine, montelukast, and intravenous hydrocortisone before subsequent L-asparaginase doses.

Main Results:

  • 76 subsequent L-asparaginase doses were administered after premedication.
  • 7 recurrent hypersensitivity reactions (9.2%) occurred in 6 patients, mostly mild.
  • All patients completed their L-asparaginase therapy, with one requiring epinephrine for a severe reaction.

Conclusions:

  • The premedication protocol showed potential for safely continuing native *E. coli* L-asparaginase therapy.
  • This strategy may improve chemotherapy access for children with ALL in resource-limited settings.
  • Further research can validate this approach for managing L-asparaginase hypersensitivity.
Abstract

Keywords:
L-asparaginasechemotherapyhypersensitivityleukemiapremedication

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