1. Acute Chemotherapy related reactions

2. Adverse chemotherapy reactions
Hypersensitivity / anaphylaxis
Oxaliplatin induced laryngopharyngeal dysaesthesia
Irinotecan induced cholinergic syndrome

3. Treatment of anaphylaxis
1. Mild reaction: stop administration
administer antihistamine & steroids IV if prescribed
medical review and assessment
2. Severe reaction: stop administration
administer adrenaline IM
oxygen and IV fluids
call for urgent medical assistance

4. Chemotherapy most likely to cause anaphylaxis
Carboplatin:
- rare 1st line
- 25% risk for 2nd line
- can occur well into infusion
Taxanes: paclitaxel or docetaxel
- commonly react after only a few mls
- can often be safely restarted

5. Oxaliplatin induced laryngopharyngeal dysaesthesia
Acute sensation of difficulty in breathing / tightness in throat
Usually at the end of infusion or in the first few hours afterwards
Can be triggered by exposure to cold air / drinks
Not accompanied by drop in O2 sats, reduced air entry or hypotension

6. Prevention of laryngopharyngeal dysaesthesia
Prepare patient
Do not leave immediately after end of infusion, have a warm drink at end of infusion
No cold drinks for hours
Wear warm scarf to cover nose and throat on leaving
Do not drive yourself home
Bring car close to exit

7. Treatment of laryngopharyngeal dysaesthesia
Assess & ensure this is not anaphylaxis
Reassure
Provide warm drink
Warm patient
Observe closely – BP, O2 sats, resps
Lorazepam sublingual may be helpful if does not settle quickly

8. Irinotecan induced cholinergic syndrome
Symptoms occur during or shortly after completion of infusion;
Abdominal pain / stomach cramps
Diarrhoea
Sweating
Blurred vision
Hypotension
Increased salivation

9. Treatment & prevention of cholinergic syndrome
Treatment of acute symptoms:
Assess patient
administer atropine 250mcg subcutaneous injection
Prevention:
As distressing symptoms will occur in % of patients administer atropine 250mcg prophylaxis immediately pre infusion