Infusion reaction

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: acute infusion reaction; infusion-related reaction

Overview

Infusion reactions is defined as a reaction to the infusion of pharmacological or biological substances. Symptoms may appear within minutes to hours following the infusion and may include pruritus, flushing, swelling, dyspnea, bronchospasm, and hypotension.

Classification

Common Terminology Criteria for Adverse Events (CTCAE) Grade

“

CTCAE Grade 1 Cytokine Release Syndrome or Acute Infusion Reaction Mild reaction; infusion interruption not indicated; intervention not indicated. CTCAE Grade 2 Cytokine Release Syndrome or Acute Infusion Reaction Requires therapy or infusion interruption but responds promptly to symptomatic treatment (e.g., antihistamines, NSAIDS, narcotics, IV fluids); prophylactic medications indicated for ≤24 hrs. CTCAE Grade 3 Cytokine Release Syndrome or Acute Infusion Reaction Prolonged (i.e., not rapidly responsive to symptomatic medication and/or brief interruption of infusion); recurrence of symptoms following initial improvement; hospitalization indicated for other clinical sequelae (e.g., renal impairment, pulmonary infiltrates). CTCAE Grade 4 Cytokine Release Syndrome or Acute Infusion Reaction Life-threatening; pressor or ventilatory support indicated. CTCAE Grade 5 Cytokine Release Syndrome or Acute Infusion Reaction Death.

”

Causes

Common Causes

• Denileukin diftitox

Causes by Organ System

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Denileukin diftitox, galsulfase, Ibritumomab tiuxetan, laronidase, Pegloticase
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

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3

Diagnosis

Signs and Symptoms

• Flushing
• Itching
• Alterations in heart rate and blood pressure
• Dyspnea or chest discomfort
• Back or abdominal pain
• Fever and/or shaking chills
• Nausea, vomiting, and/or diarrhea
• Various types of skin rashes
• Throat tightening
• Hypoxia
• Seizures
• Dizziness and/or syncope
• Signs and symptoms of anaphylaxis