Allergies and short supplies

Friday was chemo day in King of Prussia – mom and Wes left the house early as usual for their third and last trip to the clinic this week. After last week’s minor setback he was due for sedation to administer PEG-L-asparaginase, one of the central components in his chemotherapy. It didn’t go well, and now we’re left wondering what’s next – no one ever said cancer therapy would be easy or the path clear, but these detours exact an emotional toll on us.

The big issue right now is his allergic reaction to PEG. The reaction itself isn’t uncommon – perhaps 30% of all patients show some sign of an allergy to it, ranging from minor itchiness to anaphylactic shock. The former can be worked through, usually through administering a strong antihistamine in conjunction with the PEG, but stronger allergic reactions can be quite dangerous, compounded by the patient being sedated, so there exists a closely related alternative drug Erwinia L-asparaginase. Thankfully, Erwinia has the same efficacy as PEG does, so it shouldn’t put Wes at greater risk, but there’s a huge complication: Erwinia has been in severe shortage for years, and it continues to be difficult come by.

One would think that manufacturers of a drug for which there’s patent protection, extortionate pricing, and a captive audience would have a great business just keeping up with the demand, but that’s a topic for another day. Today, we don’t know for sure if Wes will have to switch to Erwinaze. It’s possible they’ll push forward with PEG and try to work with the allergic reactions, at least for now. We should know more on Monday.