Melphalan allergy is an uncommon reaction to the chemotherapy drug melphalan, and it can happen during or soon after treatment. Early symptoms of melphalan allergy may include itching, a rash, hives, flushing, or trouble breathing. Many people first hear about melphalan allergy when symptoms appear during an infusion, but reactions can vary from mild skin changes to a severe emergency called anaphylaxis. Melphalan allergy usually lasts as long as the reaction itself, but future doses may trigger it again, so doctors often avoid the drug or use a different treatment plan. Treatment for melphalan allergy depends on severity and may include stopping the medicine, giving antihistamines or steroids, and using emergency care such as epinephrine if the reaction is severe.
How many people live with Melphalan allergy?
No reliable worldwide or U.S. estimate is available for how many people live with melphalan allergy. This allergy to the cancer medicine melphalan appears to be very rare and is mostly described in small case reports rather than large population counts, so consistent numbers are not currently tracked.
Overview
Melphalan allergySymptoms
Melphalan allergy can cause rash, itching, hives, wheezing, swelling, or trouble breathing soon after treatment. Some people also feel flushed, dizzy, or nauseated. Early symptoms of melphalan allergy need urgent medical attention.
Outlook and prognosis
The outlook for melphalan allergy is usually good once the reaction is recognized and melphalan is stopped or replaced. Many people do well with careful allergy assessment, slower infusions, premedication, or a different cancer treatment plan.
Causes and risk factors
Melphalan allergy happens when the immune system reacts to melphalan after prior exposure, sometimes even after small amounts. Risk may be higher in people with other drug allergies, repeated treatment courses, or a history of allergic conditions such as asthma or eczema.
Genetic influences
Genetics do not appear to be a main cause of melphalan allergy. Most reactions are thought to involve the immune system after exposure, though inherited differences may slightly affect who is more likely to react.
Diagnosis
Melphalan allergy is diagnosed from your reaction history, timing after treatment, and a review of other possible causes. There is no single standard test, so diagnosis of Melphalan allergy often relies on clinical features and careful medical assessment.
Treatment and drugs
Melphalan allergy is treated by stopping the drug and managing the reaction quickly. Many need antihistamines, steroids, or emergency epinephrine. Future cancer treatment usually switches to a different medicine, with allergy specialist input when needed.
Symptoms
Melphalan allergy can come on quickly, often during treatment or soon after, and it may affect the skin, breathing, or blood pressure. The early symptoms of Melphalan allergy may start with itching, flushing, or a sudden rash, then become more serious within minutes. Symptoms vary from person to person and can change over time. Severe reactions need urgent medical attention.
The skin may suddenly feel itchy, warm, or prickly, and raised welts can appear. In Melphalan allergy, these changes often start quickly and may spread over the body.
Redness can come on fast, especially around the face, neck, or chest, and some people feel suddenly hot. A rash may look blotchy or patchy rather than dry or delayed.
The lips, eyelids, tongue, or throat may swell within minutes. This can make swallowing, speaking, or breathing feel harder and may signal a more serious reaction.
You may notice chest tightness, wheezing, coughing, or shortness of breath. For many people with Melphalan allergy, these symptoms need immediate attention because they can worsen quickly.
How people usually first notice Melphalan allergy?
People usually first notice a melphalan allergy during or soon after treatment, when new symptoms appear that feel out of proportion to the expected side effects of the drug. Early warning signs can include itching, hives, flushing, swelling of the lips or face, shortness of breath, wheezing, dizziness, or a sudden feeling that something is very wrong. Because allergic reactions can sometimes escalate quickly, many living with a suspected melphalan allergy are first recognized when these symptoms start during an infusion or shortly afterward and need prompt medical attention.
Types of Melphalan allergy
Melphalan allergy can show up in more than one way, and the timing often helps tell the difference. Some reactions happen during treatment or soon after, while others appear hours to days later. Doctors sometimes classify symptoms as immediate versus delayed. Knowing the different types of Melphalan allergy can help explain why one person develops hives and breathing trouble, while another mainly gets a rash later on.
Immediate reaction
This type starts within minutes to a few hours after melphalan is given. People may develop itching, flushing, hives, swelling, wheezing, or a tight feeling in the chest. Symptoms can escalate quickly, so treatment teams watch for it closely during and after the infusion.
Anaphylaxis
This is the most severe immediate allergic reaction to melphalan. It can cause trouble breathing, throat swelling, dizziness, low blood pressure, or fainting, and it needs emergency treatment right away. Not everyone with an immediate reaction will develop anaphylaxis.
Delayed rash
This type appears later, often hours to several days after exposure. Many living with Melphalan allergy notice a widespread rash, itching, or red patches rather than sudden breathing symptoms. Even within the same type, intensity can range from mild to severe.
Can I slow down the onset of symptoms?
No, there is no good evidence that lifestyle changes can meaningfully delay the start of symptoms in a melphalan allergy, because reactions usually happen only when the body is exposed to the drug. The main way to reduce risk is to avoid melphalan and make sure your cancer team, pharmacist, and other doctors know about the allergy before treatment; there is no routine diet, supplement, or preventive medicine proven to stop it, although in rare cases a hospital team may use a closely watched step-by-step process if the drug is absolutely needed. This cannot guarantee that a reaction will be prevented, but careful planning can help lower the chance of a serious problem.
What genetics can tell you about symptoms
For people with melphalan allergy, genetics does not currently tell doctors much about which symptoms will happen, how severe they will be, or exactly when they will start. Unlike a few drug reactions that have clear genetic risk markers, melphalan allergy does not have well-established genetic changes that reliably predict symptom patterns in everyday care. In most cases, symptoms depend more on how the immune system reacts after exposure, and reactions can range from mild rash or itching to serious breathing problems or low blood pressure.
Causes and risk factors
Melphalan allergy happens when the immune system reacts to melphalan or, less often, to another ingredient in the treatment. The risk is usually higher after a previous exposure, because the body may have become sensitized to the drug. People with a history of drug allergies, asthma, or other severe allergies may also be at higher risk. Having risk factors doesn’t mean you’ll definitely develop the condition. No specific gene or lifestyle habit is known to cause melphalan allergy, but your overall health and other medicines given at the same time can influence risk factors for melphalan allergy.
What are the most common causes or risk factors?
Melphalan allergy is most often caused by exposure to melphalan itself, especially if someone has had this medicine before and their body has become more likely to react to it. People with a past allergic reaction to melphalan or a history of allergies to other medicines may have a higher risk, although some reactions happen without any clear warning signs. No specific inherited or genetic risk factors for melphalan allergy have been firmly proven.
Environmental and biological risk factors
Melphalan allergy is uncommon, but the chance is higher in some settings than others. Doctors often group risks into internal (biological) and external (environmental). For this kind of drug allergy, the biggest environmental factor is exposure to melphalan itself, especially if your body has reacted to it before. Biological factors such as a history of drug allergies or allergy-prone conditions may also matter.
A previous allergic reaction during or soon after melphalan is the strongest warning sign for another reaction. If melphalan allergy has happened before, the immune system may respond again with later doses.
Drug allergies often appear after the body has been exposed to the same medicine more than once. For many, this can mean the risk of melphalan allergy is higher with later treatment cycles or re-exposure after a break.
People who have had allergic reactions to other medicines may be more likely to react during chemotherapy. This does not mean melphalan allergy will happen, but it can place someone in a higher-risk group.
Asthma, eczema, hay fever, or frequent hives can go along with a more reactive immune system. Plenty of people with similar exposures live without developing the condition, but these conditions may make doctors more cautious during melphalan treatment.
Genetic risk factors
Melphalan allergy does not have a single known genetic cause, and most reactions cannot be predicted from DNA alone. At this time, the genetic risk factors for melphalan allergy are not well defined. Researchers think inherited differences in immune system genes may play a part for some people, but no specific gene change is used in routine care to forecast risk.
No proven gene: No single gene or inherited variant is known to directly cause melphalan allergy. Most people who react do not have an identifiable genetic explanation, and genetic testing is not routinely used for this purpose.
Family tendency: Allergic conditions can run in families, which may reflect inherited differences in how the immune system responds. Even so, a family history of allergies has not been shown to predict melphalan allergy specifically.
Immune genes: Researchers are studying genes that help the immune system recognize medicines and trigger allergic reactions. So far, none has been confirmed strongly enough to support routine genetic screening for melphalan allergy.
Lifestyle risk factors
Melphalan allergy is not usually driven by lifestyle in the way conditions like diabetes or heart disease are. There are no well-established diet or exercise habits that directly cause a melphalan allergy, but some day-to-day behaviors can make reactions harder to recognize, harder to manage, or riskier during treatment. In practice, understanding how lifestyle affects melphalan allergy is mostly about reducing avoidable strain on the body and avoiding anything that can confuse the clinical picture.
Alcohol does not cause a melphalan allergy, but it can worsen flushing, dizziness, nausea, or dehydration during treatment. That can make it harder to tell whether early symptoms are from the drug itself, a developing allergic reaction, or both.
Smoking does not trigger melphalan allergy directly, but it can aggravate cough, wheeze, and shortness of breath. If a reaction occurs, irritated airways may make breathing symptoms feel more severe or harder to assess.
Herbal products, over-the-counter remedies, and non-prescribed supplements can add side effects or interact with cancer treatment. This may cloud the recognition of a true allergy and complicate decisions about whether melphalan is the cause.
Delaying the reporting of itching, rash, swelling, chest tightness, or lightheadedness can allow a reaction to progress before treatment is given. A habit of minimizing symptoms or trying to push through them can increase safety risks.
Risk prevention
For people with melphalan allergy, prevention mostly means avoiding another reaction rather than preventing the allergy itself from developing. The safest approach is to make sure every clinician, pharmacist, and infusion team member knows about the allergy before any cancer treatment is given. Prevention works best when combined with regular check-ups. If melphalan is still being considered, an allergy specialist and cancer team can help weigh safer options and plan ahead.
The main way to prevent melphalan allergy symptoms is to avoid melphalan unless a specialist says otherwise. This includes checking both planned chemotherapy and any treatment records from past cancer care.
Tell every member of your care team exactly what happened during the reaction, including how fast it started and which symptoms you had. Clear details help confirm whether it was a true melphalan allergy or another treatment-related problem.
Ask for melphalan allergy to be listed clearly in your medical chart, pharmacy profile, and hospital records. Many living with melphalan allergy also find it helpful to carry a wallet card or wear a medical alert bracelet.
Your oncology team may need to review whether similar medicines or combination treatments could raise concern in your specific case. Different people need different prevention strategies—there’s no single formula.
Can you prevent Melphalan allergy?
A melphalan allergy usually cannot be fully prevented, because drug allergies are often hard to predict before someone is exposed. The best way to lower the risk is to tell your care team about any past reaction to melphalan or to other medicines, so they can avoid it or monitor you very closely if it must be used. If you have already had a reaction to melphalan, avoiding it in the future is the most important step.
Transmission
Melphalan allergy is not contagious, so it cannot be passed from one person to another through coughing, kissing, sex, blood, or everyday contact. It usually develops only in someone who has been exposed to melphalan, often as part of cancer treatment, and then has an immune reaction to the medicine.
If you are wondering whether melphalan allergy is contagious, the answer is no; the issue is personal sensitivity to the drug, not infection. Family members do not catch melphalan allergy, although a general tendency toward allergies can sometimes run in families.
When to test your genes
For melphalan allergy, genetic testing is not routinely used for early detection or to guide treatment. If you have had a prior reaction to melphalan or related chemotherapy, the key step is to tell your oncology team before treatment so they can review the reaction and plan safer options.
Diagnosis
When melphalan allergy is suspected, the diagnosis is based mainly on what happened around the time the medicine was given and on the pattern of symptoms that followed. People with melphalan allergy may develop itching, hives, flushing, swelling, wheezing, shortness of breath, or a sudden drop in blood pressure during or soon after treatment. Doctors usually begin by reviewing the reaction closely, because the diagnosis of melphalan allergy often depends more on timing and symptoms than on a single definitive test.
Your care team asks exactly when symptoms started, how severe they were, and whether they improved after melphalan was stopped or treatment was given. This helps separate a true drug allergy from side effects such as nausea, fatigue, or irritation at the infusion site.
Doctors look for signs that fit an allergic reaction, especially hives, swelling, breathing trouble, cough, or low blood pressure during or shortly after the infusion. The combination of symptoms and timing is often the most important clue in how melphalan allergy is diagnosed.
Your provider reviews other medicines given the same day, including anti-nausea drugs, antibiotics, or contrast dyes that could have caused a similar reaction. A detailed allergy and treatment history can help show whether melphalan is the most likely trigger.
If symptoms are still present, doctors check the skin, breathing, heart rate, blood pressure, and oxygen level. This helps confirm the type of reaction and guides urgent treatment if the allergy is active.
How is Melphalan allergy diagnosed?
Melphalan allergy is usually diagnosed by looking closely at what happened during or soon after treatment, especially how fast symptoms started and whether they fit an allergic reaction, such as hives, trouble breathing, flushing, or swelling. Doctors also review other possible causes, like side effects from the drug itself or reactions to other medicines given at the same time, and may have an allergy specialist assess the reaction. In some cases, the safest way to confirm it is careful testing in a medical setting, sometimes including allergy skin testing or a supervised repeat dose, but there is no routine genetic test used to diagnose melphalan allergy.
Stages of Melphalan allergy
Melphalan allergy does not have defined progression stages. That is because an allergic reaction to melphalan usually happens as a sudden episode after exposure, rather than a condition that steadily worsens over time in set steps. Doctors usually start with a conversation about when symptoms happened, how soon they started after treatment, and whether similar reactions have happened before; this can help sort out early symptoms of melphalan allergy from other side effects such as nausea or flushing. Diagnosis and monitoring usually rely on the pattern of symptoms during or after treatment, review of medicines, and close medical observation, with allergy specialist input in some cases.
Outlook and prognosis
The outlook for people with melphalan allergy is generally good if the reaction is recognized promptly and the drug is stopped or future doses are avoided. Mild allergic reactions often resolve fully with antihistamines, corticosteroids, and supportive care, while severe reactions such as anaphylaxis can be life-threatening but are usually reversible with urgent treatment including epinephrine and close monitoring. Long-term prognosis depends largely on whether melphalan is essential for cancer treatment, because an allergy may require switching to a different regimen or, in selected cases, desensitization under specialist supervision. Most patients do not have lasting health problems from the allergy itself once the acute reaction has resolved. Mortality from melphalan allergy is rare, but the risk is highest during a severe immediate hypersensitivity reaction that is not treated quickly. Overall, with careful documentation, avoidance strategies, and oncology-allergy team planning, most patients can continue cancer care safely through alternative approaches.
Long-term effects
For many people, the main long-term effects of Melphalan allergy relate less to day-to-day symptoms and more to future treatment planning. Once a true allergic reaction has happened, the biggest concern is that another exposure could trigger a faster or more severe reaction. Doctors often describe these as long-term effects or chronic outcomes. Everyone’s path looks different, and ongoing support can help when cancer care needs to be adjusted.
A past Melphalan allergy can raise the chance of another reaction if the drug is given again. In some people, repeat reactions are quicker and more serious, which is why careful review before future treatment matters.
Melphalan allergy may mean this medicine has to be avoided or used only with special precautions. For many, this can mean changes in the cancer treatment plan, including switching to other drugs if they are suitable.
The allergy usually stays important in your medical record for years because future cancer care may depend on it. Clear documentation helps reduce accidental re-exposure in hospitals, infusion centers, and emergency settings.
After a significant reaction, doctors may recommend closer monitoring with later treatments, especially if other chemotherapy drugs are used. This can include longer observation during infusions and more planning around emergency treatment if a reaction happens again.
How is it to live with Melphalan allergy?
Living with a melphalan allergy usually means the biggest changes happen around cancer treatment, because you and your care team need to avoid that drug and plan safe alternatives. For many people, this can add stress, extra questions, and closer monitoring during infusions or future medical visits, but it also helps to know that drug allergies can be documented clearly so other clinicians can act quickly to protect you. The people around you, especially family and caregivers, may need to help keep track of allergy records, medication lists, and emergency symptoms such as rash, swelling, trouble breathing, or sudden dizziness, so treatment stays as safe and steady as possible.
Treatment and drugs
Melphalan allergy is treated first by stopping melphalan right away and treating the reaction based on how serious it is. Mild reactions may improve with antihistamines and close monitoring, while more severe reactions can need urgent care with oxygen, IV fluids, steroids, and epinephrine if breathing or blood pressure are affected. Because melphalan allergy can return with repeat exposure, many people are advised to avoid the drug in the future and talk with their cancer team about other treatment options. Treatment often looks different for each person, especially if melphalan is an important part of cancer care and the team is weighing allergy risk against treatment benefit. If you notice possible early symptoms of melphalan allergy, such as flushing, itching, wheezing, or sudden dizziness during an infusion, tell the care team immediately.
Can you cure Melphalan allergy?
No, there is no cure for a melphalan allergy. Treatment focuses on avoiding melphalan, using other cancer medicines when possible, and treating allergic reactions quickly if they happen. In some cases, doctors may try a carefully supervised process to help someone receive the drug more safely, but this is not a permanent cure.
Non-drug treatment
Living with melphalan allergy can make cancer treatment feel more stressful, because reactions may happen during or soon after an infusion and can affect what treatment options feel safe. Non-drug care focuses on prevention, close monitoring, and practical steps that lower the chance of another reaction while helping you get the care you need. Managing this condition often starts with careful planning before each treatment visit, rather than waiting to respond once symptoms begin. For many, this also includes support from allergy and cancer specialists working together.
The main non-drug approach for melphalan allergy is avoiding further exposure unless a specialist decides it is necessary and can be done safely. This often means clearly documenting the allergy in your medical record and checking all treatment plans before each infusion.
Assessment by an allergist can help confirm whether melphalan was the true cause of the reaction and how serious the risk may be. This is especially helpful if the early symptoms of melphalan allergy were mild or unclear, or if other drugs were given at the same time.
If melphalan must still be considered, treatment is usually given only in a closely monitored setting with staff ready to respond quickly. Non-drug treatments may be recommended alongside this, such as slower infusion timing and extended observation during and after treatment.
Some people with melphalan allergy may be offered a carefully controlled desensitization program, where tiny doses are given step by step under specialist supervision. This does not cure the allergy, but it can sometimes allow treatment to go ahead more safely when there are limited alternatives.
Your genes may have an impact on how drugs work for you
At this time, genes are not known to have a clear, routine role in predicting who will have an allergic reaction to melphalan or in guiding the medicines used to treat that reaction. For many living with a melphalan allergy, care is based much more on what happened during the reaction, how severe it was, and what safer treatment options are available. In other words, unlike some other drug-related problems, genetic testing is not a standard part of care for melphalan allergy.
Pharmacological treatments
When melphalan allergy happens, treatment focuses on stopping the reaction quickly and preventing it from getting worse. Mild reactions may improve with allergy medicines, while severe reactions need emergency treatment right away. In people with melphalan allergy, the exact medicines used depend on whether symptoms are limited to rash and itching or include breathing trouble, dizziness, or low blood pressure. Not everyone responds to the same medication in the same way.
Epinephrine is the main emergency drug for a severe melphalan allergy reaction, especially if there is wheezing, throat swelling, or faintness. It works fast to open the airways, raise blood pressure, and slow the allergic response.
Diphenhydramine or cetirizine may be used for itching, hives, flushing, or other early symptoms of melphalan allergy. These medicines can help skin symptoms but do not replace epinephrine if the reaction is severe.
Corticosteroids such as hydrocortisone or methylprednisolone are often given to calm inflammation during a significant allergic reaction. They do not act immediately, but they may help prevent symptoms from coming back later.
Albuterol may be added if melphalan allergy causes wheezing, chest tightness, or shortness of breath. This inhaled medicine helps relax the airway muscles, but it is usually used alongside other urgent treatment.
Genetic influences
If you had a reaction during cancer treatment, it makes sense to wonder whether melphalan allergy could affect other people in your family too. It’s natural to ask whether family history plays a role. Right now, melphalan allergy is not known to be an inherited condition, and there is no specific gene test doctors use to predict it. Researchers think genes may shape how the immune system reacts to some medicines, but for melphalan allergy any genetic effect remains unclear and is not part of routine care. For most people, the main clues to melphalan allergy come from what happened when the drug was given, not from family history, so a relative with a drug allergy does not usually mean you will have the same reaction. If melphalan is being considered again, your care team will usually rely on your past reaction and an allergy assessment rather than genetic testing.
Is Melphalan allergy genetic?
Genetics do not appear to be a main cause of melphalan allergy. Most reactions are thought to involve the immune system after exposure, though inherited differences may slightly affect who is more likely to react.
Having a genetic risk is not necessarily a diagnosis
It is normal for people to have genetic variants, and these are common throughout the general population. Most of them do not directly affect health and simply reflect natural human diversity. For many genes, having a variant associated with a condition suggests a possible link rather than a certain diagnosis, especially when more than one gene and environmental factors are involved. In some cases, though, a single well-understood variant in a specific gene can be enough to confirm a diagnosis.
Pharmacogenetics—how genetics influence drug effects
If melphalan triggers an allergic reaction, treatment usually starts with stopping the drug and managing the symptoms right away. Mild reactions may be treated with antihistamines or steroids, while a severe reaction with wheezing, throat swelling, faintness, or low blood pressure can require emergency treatment with epinephrine and close monitoring. In some situations, an allergy specialist may consider a carefully supervised desensitization process if melphalan is still the best option.
Not every difference in response is genetic, but genetics do not currently play a major routine role in treating melphalan allergy. Unlike a few other drug reactions, there is no widely used genetic testing for melphalan allergy that can reliably predict who will react or which allergy treatment will work best. For many living with melphalan allergy, doctors rely more on the details of the reaction, past drug exposures, other medical conditions, and whether safer alternatives are available.
Interactions with other conditions
For people with melphalan allergy, the biggest concern is often how it can complicate cancer treatment and make it harder to use a medicine that may be part of a larger care plan. If someone already has asthma, severe seasonal allergies, or a history of drug reactions, an allergic response may be more intense or need closer monitoring, especially during or soon after treatment. Doctors call it a comorbidity when two conditions occur together. In real life, that can matter because early symptoms of melphalan allergy, such as flushing, itching, wheezing, or swelling, can overlap with signs of infection, side effects from chemotherapy, or reactions to other medicines given at the same time. Many living with melphalan allergy also need their team to review other health problems, including heart or lung disease, since a serious reaction can put extra strain on breathing and circulation. Care is usually safest when cancer specialists and allergy specialists work together to confirm the reaction and plan future treatment options.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
What other conditions can cause similar symptoms to Melphalan allergy?
A melphalan allergy can look a lot like other medicine reactions, including common side effects from melphalan itself or from other drugs given around the same time, such as antibiotics, anti-nausea medicines, or contrast dye used for scans. It can also be confused with a non-allergic reaction during an IV treatment, or less often with problems like anxiety, asthma, or a serious infection if there is trouble breathing, flushing, dizziness, or low blood pressure.
History
When melphalan began to be used more widely in cancer care in the mid-1900s, doctors focused mainly on how well it treated diseases such as multiple myeloma and ovarian cancer. Over time, they also began to notice that a small number of people developed sudden allergic reactions during or soon after treatment. For many, this can mean an infusion that starts routinely and then has to be stopped because of flushing, itching, shortness of breath, or a drop in blood pressure.
At first, these reactions were understood mostly through bedside observation rather than detailed testing. Not every early description was complete, yet together they helped doctors recognize that melphalan allergy was a real treatment-related problem and not simply anxiety, infection, or a side effect from the cancer itself. As medical science evolved, reports became clearer about the range of reactions, from mild skin symptoms to more serious responses that needed urgent care.
In recent decades, awareness has grown as cancer treatment has become more specialized and supportive care has improved. This has helped clinicians better identify early symptoms of melphalan allergy, pause treatment quickly, and decide whether it is safer to avoid the drug, use medicines beforehand to lower the chance of a reaction, or in selected cases try carefully supervised rechallenge. Knowing the condition’s history helps explain why modern cancer centers watch closely during treatment: melphalan allergy is uncommon, but it is now much better recognized than it was in the early years of chemotherapy.