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The ONS PodcastAuthor: Oncology Nursing Society
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Episode 436: Oncologic Emergencies 101: Hypersensitivity Reactions
Episode 431
Friday, 9 October, 2026
"The most important thing related to hypersensitivity reactions is that there is often a potential for rapid progression, and that's what makes these reactions an oncologic emergency. The patients may have symptoms that are mild, and that quickly can progress to respiratory compromise, hypertension, cardiovascular issues, or anaphylaxis. Early recognition is so important, so we don't want to wait for our patient to become hypotensive or significantly hypoxic before we identify that they're having a serious reaction," ONS member Christina Matousek, DNP, RN, OCN®, patient education specialist at Smilow Cancer Hospital in New Haven, CT, told Madeline Johnston, MSN, RN, OCN®, oncology clinical specialist at ONS, during a conversation about hypersensitivity reactions. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by October 9, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to managing hypersensitivity reactions in people receiving antineoplastic therapies. Episode Notes Complete this evaluation for free NCPD. ONS Podcast™ episodes: Oncologic Emergencies 101 series Episode 395: Pharmacology 101: Monoclonal Antibodies Episode 299: Pharmacology 101: Plant Alkaloids Episode 286: Pharmacology 101: Alkylating Agents Episode 283: Desensitization Strategies to Reintroduce Treatment After an Infusion-Related Reaction ONS Voice articles: Master Hypersensitivity Reactions With These Strategies for Prevention and Management Nurses Have Immediate Access to Necessary Medications and Supplies With Hypersensitivity Reaction Kits Oncology Drug Reference Sheet: Carboplatin Oncology Drug Reference Sheet: Docetaxel Oncology Drug Reference Sheet: Paclitaxel ONS book: Understanding and Managing Oncologic Emergencies: Traditional and Emerging Course: ONS Oncologic Emergencies™ Clinical Journal of Oncology Nursing articles: Early Recognition and Response of Chemotherapy-Induced Hypersensitivity Reactions: A Nursing Discussion Prophylactic Protocol for Carboplatin Hypersensitivity in High-Risk Patients With Gynecologic Cancer How Do Oncology Nurses Feel During a Hypersensitivity Reaction? ONS Oncologic Emergencies Learning Library ONS Huddle Card: Anaphylaxis To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode "Traditionally, hypersensitivity reactions are divided into four different types. Type 1 are reactions that are immediate, which are often IgE mediated and are the reactions we tend to worry most about during an infusion because they can lead to anaphylaxis. Our types 2, 3, and 4 involve different immune mechanisms and may have a more delayed presentation. But clinically, when an oncology nurse has a patient receiving an infusion and the patient suddenly says something doesn't feel right, our first priority isn't necessarily identifying the exact immunologic mechanism. It's recognizing the reaction, stopping or pausing the agent according to one's institutional protocol, assessing our patient, and then determining how severe the reaction is." TS 2:08 "The first step always, always, always is to stop or pause the infusion according to the medication and institutional protocol, and then you're immediately assessing the patient. The patient may say to you, 'I have an itchy throat.' And while they're stating that, I'm going over and shutting off the pump immediately. Treatment after that really depends on the severity of symptoms. So when the nurse is doing their assessment, they're going to be assessing, of course, airway, breathing, circulation, so our ABCs. They're going to be obtaining vital signs. They're going to get an O2 saturation. Stay with the patient, of course. Call for assistance. And then notify the appropriate provider and activate any institutional hypersensitivity protocol." TS 6:44 "For patients who still need a medication that caused a reaction, there are desensitization protocols that may sometimes allow the medication to be administered safely. These protocols use carefully controlled, progressively increasing doses, but it does require specialized monitoring and collaboration with oncology, pharmacy, and allergy specialists to ensure that the patient receives the medication safely. The most important thing is that a rechallenge should never be an automatic decision, and it really should be based on the patient's individual risk–benefit assessment and an established protocol within the institution itself." TS 11:50 "I think that this is an area where simulation and competency-based education are incredibly valuable. I know at my institution, we train all of our nurses on giving chemotherapy after they take the ONS chemotherapy immunotherapy course. We actually have our own chemotherapy skills day, and we do a simulation on hypersensitivity reactions. I think it's one thing to read a hypersensitivity protocol. I can give anyone an algorithm and tell them to read it and memorize it. But I think it's another thing to have a patient suddenly become short of breath or hypotensive when you're administering chemotherapy. The nurses really need opportunities in a safe space to practice recognizing symptoms, grading the severity of the reaction, activating the appropriate response, and locating and administering emergency medications." TS 17:27 "I think we don't talk about the psychological trauma that can happen of having a reaction to these types of drugs. For instance, someone has cancer; they're coming in for a medication that you know that they need. And suddenly they feel that they can't breathe, and they're watching the entire healthcare team rush into their room. Even when the reaction is managed successfully, the patient remembers that. So when they come in for their next infusion, they're not just receiving chemotherapy. They may be thinking, 'Is this going to happen again?' And so that's why I think oncology nursing really matters. We can explain what happened, what we're changing, what we're going to do to prevent this from happening in the future, and what we're going to do if symptoms occur again." TS 22:33
