Hypersensitivity reactions to biologics used in the treatment of allergic diseases: clinical features, diagnosis and management

Abstract

Several monoclonal antibodies have been approved by the Food and Drug Administration (FDA) to treat allergic disorders, including omalizumab, dupilumab, mepolizumab, reslizumab, benralizumab, tralokinumab and tezepelumab, and their indications continue to expand. Although the risks associated with these agents are overall low, hypersensitivity reactions have been described and are reported more frequently with increased use. We provide a comprehensive review of clinical features, diagnosis and management of hypersensitivity reactions attributed to these agents. We aim to provide useful information for the clinician managing hypersensitivity reactions to these monoclonal antibodies, as well as highlight the need for future research to address specific gaps in knowledge.

Managing Severe Adverse Reactions to Biologicals in Severe Asthma

“…Several case reports describe the onset of adverse events like arthralgia after use of omalizumab. Specifically, serum sickness-like reactions have been described, as we also reported in our communication [26,32,33].…”

“…Diagnosis of hypersensitivity reactions is difficult. Non-irritating concentrations for dupilumab skin tests have not yet been established, although some case series with a limited number of patients determined concentrations of undiluted dupilumab (150 mg/mL) for skin prick test and a dilution of 1:10 in saline for intradermal testing [32]. Since, for many patients, treatment continuation is particularly important for severe asthma management, in low-risk patients such as our case, we can safely readministered the drug.…”

Emerging and Novel Elicitors of Anaphylaxis: Collegium Internationale Allergologicum Update 2024

“…Several drugs, especially biologicals, have been associated with anaphylaxis [81]. Although the risks associated with these agents are overall low, hypersensitivity reactions have been described and are reported more frequently with increased use [82]. Omalizumab (anti-IgE) and reslizumab (anti-IL 5) product labels feature black box warnings for anaphylaxis.…”

“…The overall rate of anaphylaxis caused by omalizumab, reslizumab, and other biologics utilized for allergic diseases is low, occurring in approximately 0%-0.3% of patients. The overall risk of omalizumab-related anaphylaxis is approximately 0.1%-0.2% [82,83]. Checkpoint inhibitors, a promising drug class in oncology, have only rarely been associated with anaphylaxis [84].…”