Grading of Infusion Reaction

  • Mild, transient reaction; infusion interruption not indicated; intervention not indicated
  • Therapy infusion interruption indicated, but responds promptly to symptomatic treatment (e.g., antihistamines, NSAIDs, narcotics, IV fluids); prophylactic medications indicated for ≤24 hours
  • Prolonged (e.g., not rapidly responsive to symptomatic medication and/or brief interruption of infusion); recurrence of symptoms following initial improvement; hospitalization indicated for clinical sequelae
  • Urgent intervention indicated


  • Checkpoint inhibitor: For mild/moderate (Grade 1-2) reactions: interrupt or slow rate of infusion; monitor to recovery
  • For severe/life-threatening (Grade 3-4) reactions: Discontinue nivolumab and/or ipilimumab; manage anaphylaxis via institutional protocol; monitor. Premedication with an antipyretic and antihistamine may be considered for future doses