Which Chemo agent is associated with a high risk for hypersensitivity reaction?

• A. Methotrexate
• B. Carboplatin
• C. Cytarabine
• D. Busulfan

Answer: (B)

Hypersensitivity reactions to chemotherapy are most likely with platinum-based drugs because the immune system can become sensitized to the platinum complex after repeated exposure. When a patient receives multiple cycles, the risk of an immediate hypersensitivity reaction increases, and these reactions can occur during the infusion or soon after, with symptoms such as flushing, hives, itching, wheezing, shortness of breath, or even low blood pressure.

Among the options, the drug associated with a notably higher risk of hypersensitivity is the platinum compound. While it is generally well tolerated in early cycles, the chance of a hypersensitivity reaction rises with cumulative exposure, and clinicians often anticipate this by monitoring closely during later cycles and preparing to manage reactions if they occur. Premedication and slower infusion rates are common mitigation steps, and in some cases desensitization protocols may be used for future cycles.

In contrast, methotrexate’s major risks are nephrotoxicity, hepatotoxicity, and mucositis rather than hypersensitivity; cytarabine is more associated with the ara-C syndrome (fever and myalgia) than true IgE-mediated hypersensitivity; busulfan’s notable toxicities include seizures and hepatic veno-occlusive disease rather than hypersensitivity reactions.