---
title: "Anaphylactic reaction to dacarbazine on second infusion in Hodgkin lymphoma patient"
id: "pubmed-42578872"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42578872"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42578872/"
doi: "10.1177/10781552261477104"
published_at: "2026-08-11T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Anaphylactic reaction to dacarbazine on second infusion in Hodgkin lymphoma patient
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42578872
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42578872/)
- **DOI:** [10.1177/10781552261477104](https://doi.org/10.1177%2F10781552261477104)
- **Published At:** 2026-08-11T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Case report describes a 69-year-old man with classical **Hodgkin lymphoma** treated with nivolumab, doxorubicin, vinblastine, and **dacarbazine** (N + AVD) on a day 1 and 15 schedule every 28 days. - The patient tolerated the first infusion (day 1) of cycle 1 without complications but developed a severe **anaphylactic** reaction 5 minutes after starting the dacarbazine infusion on day 15. - Symptoms included hypoxia (oxygen saturation declined to 82%), shivering, pruritus (itching), and laryngeal edema. - Initial treatments were interruption of dacarbazine and administration of 10 mg IV chlorphenamine and 200 mg IV hydrocortisone; these measures did not produce improvement. - Administration of 0.3 mg intramuscular **epinephrine** resulted in improvement of hypoxia and laryngeal edema. - The patient was transferred to the intensive care unit for observation because of the risk of a biphasic anaphylactic reaction; he remained hemodynamically stable and oxygen saturation improved to 90–93%. - Dacarbazine was discontinued permanently; the patient continued nivolumab, doxorubicin, and vinblastine (N + AV) for five cycles and achieved a complete metabolic response. - The authors emphasize that life-threatening allergic reactions to dacarbazine can occur despite prior tolerance and advise clinicians to remain vigilant during subsequent infusions even when initial doses are tolerated. - Keywords reported in the source include Dacarbazine; Hodgkin's lymphoma; adverse event; anaphylaxis; epinephrine; reaction.
## Clinical Analysis & Structured Key Points
Clipboard, Search History, and several other advanced features are temporarily unavailable. [ Skip to main page content ](https://pubmed.ncbi.nlm.nih.gov/42578872/#article-details) ![U.S. flag](https://cdn.ncbi.nlm.nih.gov/coreutils/uswds/img/favicons/favicon-57.png) An official website of the United States government Here's how you know ![Dot gov](https://cdn.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-dot-gov.svg) **The .gov means it’s official.** Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site. ![Https](https://cdn.ncbi.nlm.nih.gov/coreutils/uswds/img/icon-https.svg) **The site is secure.** The **https://** ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. [ ![NIH NLM Logo](https://cdn.ncbi.nlm.nih.gov/coreutils/nwds/img/logos/AgencyLogo.svg) ](https://www.ncbi.nlm.nih.gov/) [Log in](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42578872%2F) Show account info Close #### Account Logged in as: **username** * [Dashboard](https://www.ncbi.nlm.nih.gov/myncbi/) * [Publications](https://www.ncbi.nlm.nih.gov/myncbi/collections/bibliography/) * [Account settings](https://www.ncbi.nlm.nih.gov/account/settings/) * [Log out](https://www.ncbi.nlm.nih.gov/account/signout/?back_url=https%3A//pubmed.ncbi.nlm.nih.gov/42578872/) [Access keys](https://www.ncbi.nlm.nih.gov/guide/browsers/#ncbi_accesskeys) [NCBI Homepage](https://www.ncbi.nlm.nih.gov) [MyNCBI Homepage](https://pubmed.ncbi.nlm.nih.gov/myncbi/) [Main Content](https://pubmed.ncbi.nlm.nih.gov/42578872/#maincontent) [Main Navigation](https://pubmed.ncbi.nlm.nih.gov/42578872/) [ ![pubmed logo](https://cdn.ncbi.nlm.nih.gov/pubmed/af7de7da-df5d-41c6-8de4-8c266af8ccfb/core/images/pubmed-logo-blue.svg) ](https://pubmed.ncbi.nlm.nih.gov/) [ ](https://pubmed.ncbi.nlm.nih.gov/42578872/ "Show search bar") Search: [](https://pubmed.ncbi.nlm.nih.gov/42578872/ "Clear search input")Search [Advanced](https://pubmed.ncbi.nlm.nih.gov/advanced/) [ Clipboard ](https://pubmed.ncbi.nlm.nih.gov/clipboard/) [ User Guide ](https://pubmed.ncbi.nlm.nih.gov/help/) Save Email Send to * [ Clipboard ](https://pubmed.ncbi.nlm.nih.gov/42578872/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42578872%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42578872%2F%23open-collections-panel) * [Citation manager](https://pubmed.ncbi.nlm.nih.gov/42578872/) Display options Display options Format Abstract PubMed PMID ## Save citation to file Format: Summary (text) PubMed PMID Abstract (text) CSV Create file Cancel ## Email citation Email address has not been verified. Go to [ My NCBI account settings ](https://account.ncbi.nlm.nih.gov/settings/) to confirm your email and then refresh this page. To: Subject: Body: Format: Summary Summary (text) Abstract Abstract (text) MeSH and other data Send email Cancel ### Add to Collections * Create a new collection * Add to an existing collection Name your collection: Name must be less than 100 characters Choose a collection: Unable to load your collection due to an error [Please try again](https://pubmed.ncbi.nlm.nih.gov/42578872/) Add Cancel ### Add to My Bibliography * My Bibliography Unable to load your delegates due to an error [Please try again](https://pubmed.ncbi.nlm.nih.gov/42578872/) Add Cancel ## Your saved search Name of saved search: Search terms: [Test search terms](https://pubmed.ncbi.nlm.nih.gov/42578872/) Would you like email updates of new search results? Saved Search Alert Radio Buttons * Yes * No Email: ([change](https://www.ncbi.nlm.nih.gov/account/settings/)) Frequency: Monthly Weekly Daily Which day? The first Sunday The first Monday The first Tuesday The first Wednesday The first Thursday The first Friday The first Saturday The first day The first weekday Which day? Sunday Monday Tuesday Wednesday Thursday Friday Saturday Report format: Summary Summary (text) Abstract Abstract (text) PubMed Send at most: 1 item 5 items 10 items 20 items 50 items 100 items 200 items Send even when there aren't any new results Optional text in email: Save Cancel ## Create a file for external citation management software Create file Cancel ## Your RSS Feed Name of RSS Feed: Number of items displayed: 5 10 15 20 50 100 Create RSS Cancel RSS Link Copy ### Actions Cite Collections Add to Collections * Create a new collection * Add to an existing collection Name your collection: Name must be less than 100 characters Choose a collection: Unable to load your collection due to an error [Please try again](https://pubmed.ncbi.nlm.nih.gov/42578872/) Add Cancel Permalink Permalink Copy Display options Display options Format Abstract PubMed PMID ### Page navigation * [ Title & authors ](https://pubmed.ncbi.nlm.nih.gov/42578872/#heading) * [ Abstract ](https://pubmed.ncbi.nlm.nih.gov/42578872/#abstract) Title & authors Abstract J Oncol Pharm Pract Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Oncol+Pharm+Pract%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Oncol+Pharm+Pract%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42578872/) . 2026 Aug 11:10781552261477104. doi: 10.1177/10781552261477104. Online ahead of print. # Anaphylactic reaction to the second dose of dacarbazine following initial exposure in patient with hodgkin lymphoma [Nour Faqeer](https://pubmed.ncbi.nlm.nih.gov/?term=Faqeer+N&cauthor_id=42578872)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42578872/#full-view-affiliation-1 "Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan."), [Naheel Said](https://pubmed.ncbi.nlm.nih.gov/?term=Said+N&cauthor_id=42578872)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42578872/#full-view-affiliation-1 "Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan."), [Tasnim Quran](https://pubmed.ncbi.nlm.nih.gov/?term=Quran+T&cauthor_id=42578872)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42578872/#full-view-affiliation-1 "Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan."), [Khalid Halahleh](https://pubmed.ncbi.nlm.nih.gov/?term=Halahleh+K&cauthor_id=42578872)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42578872/#full-view-affiliation-2 "Department of Internal Medicine, Medical Oncology section, BMT& Cellular Program, King Hussein Cancer Center, Amman, Jordan.") Affiliations Expand ### Affiliations * 1 Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan. * 2 Department of Internal Medicine, Medical Oncology section, BMT& Cellular Program, King Hussein Cancer Center, Amman, Jordan. * PMID: **42578872** * DOI: [ 10.1177/10781552261477104 ](https://doi.org/10.1177/10781552261477104) Item in Clipboard # Anaphylactic reaction to the second dose of dacarbazine following initial exposure in patient with hodgkin lymphoma Nour Faqeer et al. J Oncol Pharm Pract. 2026. Show details Display options Display options Format Abstract PubMed PMID J Oncol Pharm Pract Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Oncol+Pharm+Pract%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Oncol+Pharm+Pract%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42578872/) . 2026 Aug 11:10781552261477104. doi: 10.1177/10781552261477104. Online ahead of print. ### Authors [Nour Faqeer](https://pubmed.ncbi.nlm.nih.gov/?term=Faqeer+N&cauthor_id=42578872)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42578872/#short-view-affiliation-1 "Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan."), [Naheel Said](https://pubmed.ncbi.nlm.nih.gov/?term=Said+N&cauthor_id=42578872)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42578872/#short-view-affiliation-1 "Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan."), [Tasnim Quran](https://pubmed.ncbi.nlm.nih.gov/?term=Quran+T&cauthor_id=42578872)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42578872/#short-view-affiliation-1 "Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan."), [Khalid Halahleh](https://pubmed.ncbi.nlm.nih.gov/?term=Halahleh+K&cauthor_id=42578872)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42578872/#short-view-affiliation-2 "Department of Internal Medicine, Medical Oncology section, BMT& Cellular Program, King Hussein Cancer Center, Amman, Jordan.") ### Affiliations * 1 Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan. * 2 Department of Internal Medicine, Medical Oncology section, BMT& Cellular Program, King Hussein Cancer Center, Amman, Jordan. * PMID: **42578872** * DOI: [ 10.1177/10781552261477104 ](https://doi.org/10.1177/10781552261477104) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract IntroductionDacarbazine is generally well-tolerated, apart from its hematologic toxicities; however, rare and life-threatening anaphylactic reactions have been reported. We aimed to describe a rare case of anaphylactic reaction to dacarbazine following a previously tolerated first dose.Case ReportWe report a case of a 69-year-old male patient with classical Hodgkin lymphoma, who was planned for nivolumab, doxorubicin, vinblastine, and dacarbazine (N + AVD) combination, day 1 and 15 every 28 days. The patient received day 1 of cycle#1, without any complications. On day 15, the patient developed a severe anaphylactic reaction 5 min after the start of dacarbazine infusion. The reaction was manifested by hypoxia, shivering, itching, and laryngeal edema.Management & OutcomePatient required immediate interruption of dacarbazine infusion and received 10 mg of intravenous chlorphenamine and 200 mg of intravenous hydrocortisone initially with no improvement. Hypoxia and laryngeal edema improved following the administration of 0.3 mg intramuscular epinephrine. The patient was transferred to the intensive care unit for close monitoring due to increased risk of biphasic anaphylactic reaction, in which symptoms can recur after initial resolution. Oxygen saturation improved from 82% to 90-93%, and the patient remained hemodynamically stable without complications. Dacarbazine was discontinued. Patient continued nivolumab, doxorubicin, and vinblastine (N + AV) for five cycles, and achieved complete metabolic response.DiscussionThis case highlights that anaphylactic reaction to dacarbazine may occur despite prior tolerance to the first dose. Physicians should suspect reaction during subsequent infusions of dacarbazine, even when initial cycle is tolerated. **Keywords:** Dacarbazine; Hodgkin's lymphoma; adverse event; anaphylaxis; epinephrine; reaction. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) [x] Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM **Send To** * [Clipboard](https://pubmed.ncbi.nlm.nih.gov/42578872/) * [Email](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42578872%2F%23open-email-panel) * [Save](https://pubmed.ncbi.nlm.nih.gov/42578872/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42578872%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42578872%2F%23open-collections-panel) * [Citation Manager](https://pubmed.ncbi.nlm.nih.gov/42578872/) [x] NCBI Literature Resources [MeSH](https://www.ncbi.nlm.nih.gov/mesh/) [PMC](https://www.ncbi.nlm.nih.gov/pmc/) [Bookshelf](https://www.ncbi.nlm.nih.gov/books) [Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited. Follow NCBI [ Twitter ](https://twitter.com/ncbi) [ Facebook ](https://www.facebook.com/ncbi.nlm) [ LinkedIn ](https://www.linkedin.com/company/ncbinlm) [ GitHub ](https://github.com/ncbi) [ ](https://ncbiinsights.ncbi.nlm.nih.gov/) [Connect with NLM](https://www.nlm.nih.gov/socialmedia/index.html) * [ Twitter ](https://twitter.com/NLM_NIH) * [ SM-Facebook ](https://www.facebook.com/nationallibraryofmedicine) * [ SM-Youtube ](https://www.youtube.com/user/NLMNIH) National Library of Medicine [8600 Rockville Pike Bethesda, MD 20894](https://www.google.com/maps/place/8600+Rockville+Pike,+Bethesda,+MD+20894/@38.9959508,-77.101021,17z/data=!3m1!4b1!4m5!3m4!1s0x89b7c95e25765ddb:0x19156f88b27635b8!8m2!3d38.9959508!4d-77.0988323) [Web Policies](https://www.nlm.nih.gov/web_policies.html) [FOIA](https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/freedom-information-act-office) [HHS Vulnerability Disclosure](https://www.hhs.gov/vulnerability-disclosure-policy/index.html) [Help](https://support.nlm.nih.gov/?pagename=pubmed%3Apubmed%3Aabstract%3ANONE) [Accessibility](https://www.nlm.nih.gov/accessibility.html) [Careers](https://www.nlm.nih.gov/careers/careers.html) * [NLM](https://www.nlm.nih.gov/) * [NIH](https://www.nih.gov/) * [HHS](https://www.hhs.gov/) * [USA.gov](https://www.usa.gov/) ![](https://pubmed.ncbi.nlm.nih.gov/stat?HTTP_REFERER=&SELF_URL=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42578872%2F&browserheight=600&browserwidth=1080&colorDepth=24&connection_effectivetype=4g&connection_type=&cookieSize=382&cookieenabled=true&is_browser_supported=true&jsevent=render&jsloadtime=&jsperf_basePage=44&jsperf_connect=12&jsperf_dns=0&jsperf_navTimingNetworkMS=591&jsperf_navTimingRedirectCount=0&jsperf_navTimingType=navigate&jsperf_navType=0&jsperf_redirectCount=0&jsperf_ttfb=533&jsrendertime=&language_code=en-US&log_category=literature&log_displayeduids=42578872&log_op=retrieve&log_source_db=pubmed&myncbi_signed_in=false&ncbi_algorithm=&ncbi_app=pubmed&ncbi_cost_center=pubmed&ncbi_db=pubmed&ncbi_featured_srcdb=&ncbi_nwds=yes&ncbi_nwds_ver=1.2.5&ncbi_pcid=&ncbi_pdid=abstract&ncbi_phid=00DE0001B7D31CF500003D4A9EFBD4A7.1.m_3&ncbi_program=&ncbi_timesinceload=10&ncbi_timesincenavstart=1038&ncbi_uid=42578872&pagename=pubmed%3Apubmed%3Aabstract%3ANONE&pinger_in_iframe=false&prev_phid=ED5A0001EF997D25000041318F7B2C83.1.m_3&screenavailheight=600&screenavailwidth=1080&screenheight=600&screenwidth=1080&server=pubmed.ncbi.nlm.nih.gov&sgSource=native&sgversion=0.42.0&sgversion_hotfix=0&sgversion_major=0&sgversion_minor=42&spa_index=0)![](https://pubmed.ncbi.nlm.nih.gov/stat?browserheight=600&browserwidth=1080&colorDepth=24&connection_effectivetype=4g&connection_type=&cookieSize=378&cookieenabled=true&is_browser_supported=true&jsevent=domready&language_code=en-US&log_category=literature&log_displayeduids=42578872&log_op=retrieve&log_source_db=pubmed&myncbi_signed_in=false&ncbi_algorithm=&ncbi_app=pubmed&ncbi_cost_center=pubmed&ncbi_db=pubmed&ncbi_featured_srcdb=&ncbi_nwds=yes&ncbi_nwds_ver=1.2.5&ncbi_pcid=&ncbi_pdid=abstract&ncbi_phid=00DE0001B7D31CF500003D4A9EFBD4A7.1.m_3&ncbi_program=&ncbi_timesinceload=42&ncbi_timesincenavstart=1070&ncbi_uid=42578872&pagename=pubmed%3Apubmed%3Aabstract%3ANONE&pinger_in_iframe=false&screenavailheight=600&screenavailwidth=1080&screenheight=600&screenwidth=1080&server=pubmed.ncbi.nlm.nih.gov&sgSource=native&sgversion=0.42.0&sgversion_hotfix=0&sgversion_major=0&sgversion_minor=42&spa_index=0)
## Related Clinical Research

- [Response-Adapted Bladder Preservation in MIBC: RETAIN-2 Phase II Results and ctDNA Dynamics](https://medichelpline.com/clinical-feed/medrxiv-2-response-adapted-bladder-preservation-in-muscle-invasive-bladder-cancer-results.md)
- [Cost-effectiveness of perioperative pembrolizumab plus enfortumab vedotin for cisplatin-ineligible](https://medichelpline.com/clinical-feed/pubmed-42610318.md) (DOI: 10.1080/13696998.2026.2713865)
- [Doxorubicin plus Paclitaxel: Repurposed combination with potential activity in diffuse large B‑cel](https://medichelpline.com/clinical-feed/pubmed-42235267.md) (DOI: 10.1016/j.compbiomed.2026.111781)
- [GAA as a Prognostic Biomarker and Therapeutic Target in Angioimmunoblastic T‑cell Lymphoma — Full](https://medichelpline.com/clinical-feed/frontiers-in-immunology-16-multi-omics-analysis-identifies-gaa-as-an-independent-poor-prognostic-biomarker.md)
- [CXCR4 and PD-1 blockade overcomes stroma-driven T-cell exclusion and exhaustion in PDAC 3D models](https://medichelpline.com/clinical-feed/frontiers-in-immunology-17-targeting-stroma-mediated-t-cell-exclusion-and-functional-exhaustion-in.md)

## Navigation
- [← Back to Critical Care Feed](https://medichelpline.com/clinical-feed/critical-care.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.