[Anaphylactic reaction in cyclophosphamide infusion].

Area of Science:

• Oncology
• Immunology
• Pharmacology

Background:

• Chemotherapy agents, including cyclophosphamide, are known to induce hypersensitivity reactions.
• Generalized urticaria from cyclophosphamide has been documented in five previous cases.
• Hypersensitivity reactions pose a significant clinical challenge in cancer treatment.

Observation:

• A 25-year-old patient diagnosed with Hodgkin lymphoma experienced immediate anaphylactic shock after intravenous cyclophosphamide administration.
• The patient presented with significantly elevated total serum IgE levels (1280 U/ml).
• Epicutaneous skin testing revealed a highly positive papulo-vesicular reaction to cyclophosphamide.

Findings:

• The observed anaphylactic shock represents a severe hypersensitivity reaction to cyclophosphamide.
• Elevated serum IgE levels suggest an IgE-mediated hypersensitivity mechanism.
• Positive skin test results confirm specific IgE-mediated hypersensitivity to cyclophosphamide.

Implications:

• This case highlights the potential for severe, immediate hypersensitivity reactions to cyclophosphamide beyond previously reported urticaria.
• Clinicians should be vigilant for anaphylaxis in patients receiving cyclophosphamide, especially those with elevated IgE.
• Diagnostic skin testing can be valuable in confirming cyclophosphamide hypersensitivity and guiding future treatment strategies.