Management of an anaphylactoid reaction to methotrexate with a stepwise graded challenge

We report the management of a 15‐year‐old boy with an anaphylactic or anaphylactoid response to his first dose of methotrexate during induction therapy for acute lymphoblastic leukemia (ALL). Because weekly methotrexate therapy is an important component of continuation chemotherapy for pediatric ALL, a stepwise graded challenge was employed to achieve drug tolerance.