Cancer patients receiving intravenous chemotherapy infusions can sometimes be allergic to the very drug designed to save them. “At Montefiore, patients who suffer an allergic reaction to their anti-cancer drug can undergo desensitization - decreasing a patient’s sensitivity over time - which can keep the patient on the drug of choice for their malignancy and can improve the prognosis," said Merhunisa Karagic, MD, an attending allergist and director of Montefiore’s Chemotherapy and Biologic Agent Desensitization program.
Allergic and hypersensitivity reactions from chemo infusions can vary from itching, hives, swelling, wheezing, or redness over the body to anaphylactic shock, heart attack, and even death. Previously, patients with severe hypersensitivity reactions were sent to the ICU.
At Montefiore’s Infusion Center on Eastchester Road, Dr. Karagic works with the Oncology team - attendings, nurses, and pharmacists - to help modify a patient’s immune response to a drug so that they can better tolerate it. The program is a collaborative effort between the Division of Allergy & Immunology’s Drug Allergy Desensitization Center and the Montefiore Einstein Center for Cancer Care.
Dr. Karagic recently worked with a 58-year-old pancreatic cancer patient who broke out in a rash and had difficulty breathing during her first infusion of the chemo drug Abraxane.
“Dr. Karagic saved my life,” said the Parkchester resident, who has since completed three chemotherapy treatments at full dose after initially undergoing challenge protocol.
Prior to desensitization, Dr. Karagic will perform a skin test to determine the cause of the reaction. This may be followed by a drug challenge or desensitization, depending on the reaction and skin testing results.
During desensitization, the drug is administered in incremental steps in varying dilutions, from less to more concentrated, increasing the dose every 15 to 20 minutes. Oncology nurse Dina Chowdhury takes the patient’s vital signs every 15 minutes. The oncology team also includes: pharmacists Jim McCarty and Pragna Patel; Michelle Allan, administrative manager; and Ashley Arelanno, administrative nursing manager.
In most cases, the patient can safely receive the prescribed dosage of the medication they need within five to seven hours, without a reaction. “ They get the full dose, just in a different way,” Dr. Karagic said, noting that some patients can return to their treatment without desensitization.
Patients are not required to be admitted to the hospital in order to be desensitized, making Montefiore’s program unique in New York — and one that is long overdue.
“While we have successfully built a drug allergy center at Montefiore that currently serves the Greater New York and the Tri-State Area for the past ten years, building the chemo/biologic program has been a challenge, mostly due to the number of people involved and the need to coordinate the desensitizations and testing,” said Elina Jerschow, MD, Director of the Montefiore Drug Allergy Center and Associate Professor of Medicine (Allergy & Immunology) and Microbiology & Immunology. “Dr. Karagic’s dedication and compassion to her patients has made it possible,”
In addition to managing hypersensitivity reactions in patients receiving chemotherapy, Dr. Karagic treats a multitude of allergic disorders, including environmental and food allergies, asthma, urticaria, atopic dermatitis, contact dermatitis, and drug allergies. She serves as the co-director of the Drug Allergy Center and will continue to build the Chemotherapy and Biological Desensitization Program at Montefiore. After completing a two-year fellowship in allergy and immunology at Montefiore Einstein under the mentorship of Dr. Jerschow, Dr. Karagic joined the faculty as Assistant Professor of Medicine in the division of allergy and immunology and an attending physician at Montefiore Einstein and North Central Bronx Hospitals.
To learn more about the Drug Allergy Center go to www.einstein.yu.edu/departments/medicine/allergy/
Posted on: Tuesday, March 03, 2020