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Episode 436: Oncologic Emergencies 101: Hypersensitivity Reactions

Release Date: 10/09/2026

Episode 437: Precision Oncology: What We’ve Learned and What’s Ahead

The ONS Podcast

“Biomarker testing isn’t just about generating more information. It’s about answering very practical questions for our patients. Can we identify disease earlier? Can we understand whether treatment is working? Are we able to identify why a cancer has become resistant? Ultimately, I think that’s where precision oncology becomes very meaningful. It’s not about the molecular report sitting in the chart. It’s about taking that information and using it to make the best possible decision for our individual patients,” ONS member Erica Bello Rodriguez, MSN, AGNP, NP-C, AOCNP®, oncology...

Episode 436: Oncologic Emergencies 101: Hypersensitivity Reactions

The ONS Podcast

“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...

Episode 435: An Overview of Hodgkin Lymphoma for Oncology Nurses

The ONS Podcast

“The accumulation of these malignant and reactive cells, that’s what causes the lymph nodes to get big. That’s why they grow. And that’s why the classic presentation is persistent, painless, enlarged lymph nodes. So when we think of the pathophysiology of Hodgkin lymphoma, there are really two processes contributing to the presentation: One is the physical effects of enlarging lymph nodes or the involved organs. The second is the systemic inflammatory response generated by it and its surrounding immune environment,” ONS member Victoria Krogg, DNP, APRN-CNP, AOCNP®, nurse...

Episode 434: Oncology–Psychiatric RN Collaboration to Support Psychosocial Health

The ONS Podcast

“Nurses are the front line. Oncology nurses see their patients almost all day. If you’re noticing that anxiety is causing significant distress or anxiety is disrupting a patient’s ability to concentrate during medical conversations or decision-making—anytime you’re seeing significant distress or disruption to functioning, that’s a pretty good indicator that referral to a psychiatric nurse and psychiatric care could be very helpful for that patient,” Amber Altidor, DNP, APRN-FPA, PMHNP-BC, assistant professor at Rush University College of Nursing and psychiatric nurse practitioner...

Episode 433: Cancer Treatments for Noncancer Indications: Chemotherapy/Immunotherapy

The ONS Podcast

“Unlike our cancer indications where we use these medications often to activate the immune system to target cancerous cells, in noncancer indications, the goal is really to either suppress an overactive immune or inflammatory cells or modulate the immune system. Immune modulation by use of chemotherapy and immunotherapy can help reduce abnormal inflammation, decrease autoantibody production, and also can alter T-cell and B-cell activity,” ONS member Kelsey Miller, MSN, RN, AGCNS-BC, OCN®, clinical nurse specialist in oncology and infusion therapy at Reading Hospital in West Reading, PA,...

Episode 432: Long-Term Chronic Lymphocytic Leukemia Considerations for Oncology Nurses

The ONS Podcast

“It’s a chronic disease. It never goes away for some people, and so therefore it has these periods of remission where it’s really quiet and well controlled. Then there can be periods of flares where you’re actively engaged in treatment or it’s impacting other pieces. There’s this feeling patients have of, ‘When am I going to have that flare?’ You know, this anticipatory anxiety of, ‘When are things going to be done differently?’ or ‘When do I need to change?’” ONS member Caitlin Murphy, DNP, APRN, FNP-BC, AOCNP®, chief nurse practitioner at Dana-Farber Cancer...

Episode 431: Oncologic Emergencies 101: Urinary Obstruction

The ONS Podcast

“Think about all the important things our kidneys do for the body. Those things are compromised. If we have excess buildup of toxins and waste in the body, you’re having problems with fluid reabsorption. Then you have also problems with electrolytes not being balanced. Then in turn, you have ongoing shutdown of systems. So the cardiopulmonary system gets compromise. Your circulatory system then gets compromised. And then all the things in the body that depend upon ongoing circulatory flow are then causing major resets in the system that need to be addressed,” ONS member Brenda S....

Episode 430: Leadership Unlocked: Is It Your Time to Serve?

The ONS Podcast

“If you are considering board service, I would say take the leap. Start with your local chapter. It will give you some valuable skills that will help prepare you when you are applying for your national level. And I always say, if you want to do it, just do it because what’s the worst that can happen? They can say no, but that doesn’t mean that you will never serve on a board. I always tell people delayed is not denied,” Cassandra Green, DNP, RN, OCN®, ONS member and past president of the Oncology Nursing Certification Corporation (ONCC) Board of Directors, told Evelyn Wempe, DNP,...

Episode 429: Radiation Site-Specific Side Effects: CNS Cancers

The ONS Podcast

“They’re really worried that radiation is going to be painful. So they come in for that first day of treatment very anxious. With our patients with brain cancer, we’re using the masks on the table, and those masks are very tight and hold their heads very, very still. So they’ll be very worried about being claustrophobic. We may start out the first day or two with a little bit of [lorazepam]. And they’ll come to me and they’ll say, ‘This really hasn’t been as bad as I thought it was going to be,’” ONS member Catherine McCluskey, BSN, RN, OCN®, ROCN™, radiation oncology...

Episode 428: Chronic Lymphocytic Leukemia Treatment Considerations for Oncology Nurses

The ONS Podcast

“Measurable residual disease is where I think the terminology fits best in that, it is intended to measure the amount of cancer cells that are present in the blood or bone marrow at the time the sample was collected. We can identify one cancer cell in a million. Where that can be really valuable is when we start to think about the duration of treatments and the response to some of our treatments,” ONS member Caitlin Murphy, DNP, APRN, FNP-BC, AOCNP®, chief nurse practitioner at Dana-Farber Cancer Institute in Boston, MA, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical...

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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

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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

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