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Comparison of L-Asparaginase Skin Test According to Test Interval in the Treatment of Pediatric Acute Lymphoblastic Leukemia
J. Kor. Soc. Health-syst. Pharm. 2018;35:59-66
Published online February 28, 2018
© 2018 Korean Society of Health-System Pharmacists

Kyung-Duck Kima, Ae-Ryoung Parka, Soon-Joo Kima, Shin-Yi Hwangboa and Hyen-O Lab,†

Department of Pharmacy, The Catholic University of Korea Seoul ST. Mary’s Hospitala, College of Pharmacy, The Catholic University of Koreab 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Koreaa 43 Jibong-ro, Bucheon-si, Gyeonggi-do, 14662, Republic of Koreab
Correspondence to: 나현오 Tel:02-2164-6598 E-mail:hola@catholic.ac.kr
Received July 5, 2017; Revised August 18, 2017; Accepted December 28, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background and Objective : L-asparaginase is the chemotherapeutic agent for the treatment of acute lymphoblastic leukemia and is associated with hypersensitivity reactions. Because of the high rates of hypersensitivity reactions, skin test has been proposed. However, the method of skin test not standardized, and false-positive and false-negative results have been documented. We have conducted skin tests prior to every dose of L-asparaginase. In consideration of the convenience of administration, the skin test is changed to be conducted prior to the first dose of L-asparaginase and prior to restarting therapy after an interval of a week or more has elapsed between doses by intervention of a pediatric oncology pharmacist. The objective of this study was to evaluate the sensitivity and specificity of skin tests.
Methods : From July-December 2012, patients that received skin tests prior to every dose of L-asparaginase were classified A group. From July-December 2013, patients that received skin tests prior to the first dose of L-asparaginase and prior to restarting therapy after an interval of a week or more has elapsed between doses were classified B group.
Results : 63 patients were included in the A group and received 402 cases of skin tests. 65 patients were included in the B group and received 126 cases of skin tests. The sensitivity of skin tests in the B group (52.2%) was superior to the A group (20%). This result showed statistically significant difference (p=0.047). The specificity of skin tests in the A group (96.1%) was superior to the B group (90.3%). This result showed statistically significant difference (p=0.017).
Conclusion : In conclusion, reducing the number of skin tests by intervention of a pediatric oncology pharmacist improved convenience of administration and enhanced clinical safety of chemotherapy.
Keywords : L-asparaginase, Skin test, Hypersensitivity


August 2018, 35 (3)