# Infusion and hypersensitivity reactions during anticancer treatment: recognition, emergency treatment and rechallenge

Source: https://onco.cc/protocols/infusion-reaction-management/  
OnCo record `infusion-reaction-management` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Some cancer drugs can cause a reaction while they go in: flushing, itching, a rash, chills, tightness in the chest or throat, or feeling faint. Tell the nurse at once. They will stop the drip and check you; most reactions are mild and settle, and many people can then carry on more slowly. A severe allergic reaction (anaphylaxis) is treated at once with an adrenaline injection into the thigh.

## Summary

ESMO (2017) is the only oncology guideline read; it is mostly graded [V, C] (expert opinion), because reactions are unpredictable and hard to study in trials. Preparation: ask about allergy and atopy, check oral premedication was taken, have the protocol and resuscitation equipment at hand (ESMO [V, C]; ASCO-ONS 2024 standard 3.12.7). Early odd sensations or an urge to pass urine or stool can precede a reaction and warrant blood pressure and pulse.

Management: stop the drug, keep the line, assess airway, breathing, circulation and consciousness, call for help, oxygen if needed. Anaphylaxis is treated with intramuscular adrenaline into the anterolateral thigh: ESMO gives 0.01 mg/kg up to 0.5 mL of 1 mg/mL [IV, B], repeatable every 5 to 15 minutes [V, C]; Resuscitation Council UK (2021) gives 500 micrograms for adults and repeats after 5 minutes if problems persist, with IV fluids early for shock. The two differ on adjuncts: ESMO recommends H1 plus H2 antihistamines [I, B] and allows corticosteroids against biphasic reactions [V, D]; RCUK calls antihistamines third-line, for skin symptoms after stabilisation, and no longer advises corticosteroids routinely (very low-certainty evidence). RCUK keeps the patient supine and warns against sudden sitting or standing.

Cytokine-release type reactions to antibodies (rituximab, for example) are managed by stopping, symptomatic treatment and restarting at half the rate [IV, B]. Document with a CTCAE grade [V, B]. Rechallenge with a slower rate and more premedication usually succeeds [V, C], but ESMO advises against rechallenge after grade 3 or higher or true anaphylaxis [V, B]; desensitisation in experienced centres is the alternative. RCUK refers everyone with anaphylaxis to an allergy clinic and measures tryptase when the diagnosis is uncertain.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: infusion reaction; infusion-related reaction; hypersensitivity reaction to chemotherapy; anaphylaxis in the chemotherapy unit; chemotherapy allergic reaction; taxane reaction; platinum allergy; rituximab infusion reaction; rechallenge after infusion reaction

## Connected records

- protocols: [Anticancer treatment administration checks at the chair: assessment, independent double checks and line tracing](https://onco.cc/protocols/sact-administration-checks-at-the-chair/), [Premedication against infusion reactions before taxanes, antibodies and other reaction-prone anticancer drugs](https://onco.cc/protocols/premedication-before-reaction-prone-anticancer-drugs/), [Rapid drug desensitisation after an allergic reaction to a platinum, taxane or antibody](https://onco.cc/protocols/drug-desensitisation-after-anticancer-hypersensitivity/)
- drugs: [Asparaginase (pegaspargase, calaspargase pegol, Erwinia asparaginase)](https://onco.cc/drugs/asparaginase/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Cetuximab](https://onco.cc/drugs/cetuximab/), [Daratumumab](https://onco.cc/drugs/daratumumab/), [Docetaxel](https://onco.cc/drugs/docetaxel/), [Etoposide](https://onco.cc/drugs/etoposide/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Paclitaxel / nab-paclitaxel](https://onco.cc/drugs/paclitaxel/), [Pegylated liposomal doxorubicin](https://onco.cc/drugs/pegylated-liposomal-doxorubicin/), [Rituximab](https://onco.cc/drugs/rituximab/), [Trastuzumab](https://onco.cc/drugs/trastuzumab/)
- terms: [Cytokine release syndrome (CRS)](https://onco.cc/terms/crs/), [Infusion reactions, hypersensitivity and extravasation](https://onco.cc/terms/extravasation-infusion-reaction/)

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