Docetaxel is insoluble in water. But it is soluble in a mixed solvent of polyoxyethylene castor oil and ethanol. Polyoxyethylene castor oil can release histamine in the degradation. It may cause allergic reactions. Allergic reactions occurred in the first or the second medication for most of patients. Almost all of them occur within 30 minutes after administration. Timely anti-allergy treatment can quickly relieve symptoms and will not cause serious consequences. So although docetaxel cost is reasonable and welcomes, patients should be cautious when using it in curing diseases.
The severities of allergic reactions caused by docetaxel are different. The light manifested as flushing, itching, urticaria, drug fever, a severe allergic reaction mainly hypotension, bronchospasm, asthma, and anaphylactic shock. Serious allergic reactions to the rate of 25% to 30%, pre-treatment routine to the glucocorticoid, diphenhydramine and H2 blockers by the incidence dropped to 1.5% ~ 3.0%. But the main symptoms of an allergic reaction to laryngospasm is not mentioned in the instructions of the class of drugs, clinicians should be alert to allergic reactions in the use of taxane chemotherapy. They should not just depend on drug manual guidance.
The laryngospasm is dangerous. Quickly diagnosis and differential diagnosis are particularly important. The following adverse reactions to docetaxel due to laryngospasm instant attack shortly after the start of the chemotherapy inspiratory dyspnea characterized with chemotherapy-induced phase identification; often before the onset of palpitations, shortness of breath, the main complaint, with blood pressure, migraine low heart rate and other symptoms; ECG manifested as sinus tachycardia, arrhythmia with ECG for identification; acute laryngeal edema: allergy caused by acute upper airway obstruction caused by difficulty in breathing, but the incidence of slow. In addition, the differential diagnosis should also be noted that patients with or without a history of other respiratory and circulatory system.
Anti-histamine treatment or slow down the infusion rate before chemotherapy of taxol pharmaceutical raw materials can significantly reduce allergic reaction, but still can not completely avoid a severe allergic reaction. To prevent an allergic reaction, should do the following aspects: asked in detail about the history of allergies, confirm whether the patient is allergic, do a history of record in the use of docetaxel chemotherapy; medication half an hour before intramuscular injection of diphenhydramine 20mg and intravenous cimetidine 800mg dexamethasone 10mg; ready to rescue medicines and equipment to respond rapidly to serious allergic reactions may occur; infusion bottles and infusion tube using non-PVC materials, and through the connected filters and then I slow intravenous infusion; chemotherapy during the close observation of patients with signs of change, especially within 30 minutes after the chemotherapy, more with the exchange of patient and psychological counseling. Once there are the suspects and allergic reactions, the drugs should be discontinued immediately and people should have symptomatic treatment.
The laryngospasm is abrupt onset. It will obstruct the upper respiratory tract and affect the respiratory function in short time. And the panic state will exacerbate hypoxia. If it is handled improperly, it will cause hypoxia or even death. If breathing difficulties and other symptoms occur in medication process, it should be distinguish with other serious adverse reactions. It needs a quickly diagnosis. Once the diagnosis of laryngospasm is clear, people should immediately stop the importation of all drugs and cut off the allergens. At the same time, the monitoring of vital signs should be closed. High-dose dexamethasone intravenous will inhibit allergic reactions. If there are serious wheeze, the merging bronchospasm should be considered and patients need to be injected with 0.25g of aminophylline and calcium gluconate intravenous to relieve the spasm of airway smooth muscle.