Q: You have been called to Oncology floor to manage patient who was admitted for routine chemotherapy. According to nurse, patient was just started on IV fluid and took his regular pre-chemo meds which include Dexametasone, Ranitidine, Diphenhydramine, Ondansetron and Rasburicase. It appears patient went into anaphylactic shock and required intubation and resuscitation. According to chart patient has tolerated all these meds over last one year without any problem. Which drug is the probable cause?

A) Dexametasone,

B) Ranitidine, 
C) Diphenhydramine
D) ondansetron 
E) Rasburicase


Answer: E (Rasburicase)

Rasburicase is commonly used to avoid tumor lysis syndrome. It is a unique drug in the sense that anaphylaxis is rare with first dose and is more common with repeated courses.

In general, allopurinol and intravenous hydration is the first line of management unless the patient is allergic to allopurinol, and requires Rasburicase. 



Reference:

Allen KC, Champlain AH, Cotliar JA, et al. Risk of Anaphylaxis with Repeated Courses of Rasburicase: A Research on Adverse Drug Events and Reports (RADAR) Project. Drug Saf 2015; 38:183.