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Comparison of allergic reactions to pegasparaginase given intravenously versus intramuscularly

Pegasparaginase (PEG) is important for treatment of Acute Lymphoblastic Leukemia (ALL). Despite conjugation to polyethylene glycol to reduce immunogenicity, allergic reactions still occur and may be severe. Traditionally, PEG is given via intramuscular (IM) injection but recent protocols have shown it can be safely given intravenously (IV), which may be preferred by patients. There is a potential concern that the IV route may result in more severe allergic reactions due to immediate exposure to reactive antibodies in the blood, which is delayed after IM administration. The purpose of our study is to compare the severity and incidence of allergic reactions with IV versus IM PEG. We are unaware of any prior studies examining this.