Hypersensitivity reactions to rituximab: 53 successful desensitizations in 7 patients with severe, near-fatal reactions

Lebel, Eyal; Ben‐Yehuda, Dina; Bohbot, Emilie; Dranitzki, Zvi; Shalit, Meir; Tal, Yuval

doi:10.1016/j.jaip.2016.05.013

Cited by 10 publications

(7 citation statements)

References 9 publications

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“…In rituximab-focused studies, the majority of patients who are hypersensitive react to the drug at the first exposure [6,18,19,20]. With the exception of 3 of our patients, 1 of whom reacted to infliximab and the other 2 to rituximab after multiple courses, the majority of the study patients experienced HSRs to biologic agents during the first exposure.…”

Section: Discussionmentioning

confidence: 93%

“…Nevertheless, desensitization procedures are usually effective regardless of the underlying mechanisms [5,6,7], and have been recommended when the initial reaction is moderate to severe [5,6,13,18,19,20]. Accordingly, we performed RDDs successfully even in patients who had negative skin tests with grade II and III reactions.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, rituximab was used in the treatment of patients with lymphoma, leukemia, SLE, and rheumatoid arthritis. Outside the USA, desensitization with rituximab has been described in case reports or case series [18,19,20,21,23], but we performed 87 RDDs in total, with rituximab in 14 patients, and this appears to be the highest number for rituximab desensitizations reported to date.…”

Section: Discussionmentioning

confidence: 99%

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Rapid Drug Desensitization with Biologics: A Single-Center Experience with Four Biologics

Bavbek

Kendirlinan²,

Çerçi³

et al. 2016

Int Arch Allergy Immunol

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Background: Rapid drug desensitization (RDD) induces a temporary tolerance to biologics which induce hypersensitivity reactions (HSRs). Data are limited regarding the use of RDD outside the USA. Our purpose was to report our data on RDD to rituximab, infliximab, cetuximab, and trastuzumab. Methods: The study was conducted as a retrospective chart review of patients with symptoms of HSRs to biologics. HSRs were classified as grades I, II, and III, based on their severity. Skin-prick tests/intradermal tests (IDTs) were performed with the implicated biologics. The 12-step RDD protocol was used. Results: The study group comprised 11 women and 6 men (mean age: 47 ± 11.7 years). Fourteen patients experienced HSRs to rituximab; 3 had HSRs to cetuximab, infliximab, and trastuzumab, respectively. HSRs to cetuximab, infliximab, and trastuzumab occurred during the first infusion and were all grade III. Twelve of the 14 patients with rituximab hypersensitivity had a reaction during the first infusion; 10 patients had grade II reactions and 4 had grade III reactions. Respiratory symptoms were the most frequent presentation of HSR. Skin tests with rituximab were performed on 10 patients; only 3 resulted in positive IDTs (with 1:100 dilutions) and the other tests were negative as were those performed with the other biologics. Of 96 RDDs, 89 desensitizations were performed with rituximab, 5 with cetuximab, 1 with infliximab, and 1 with trastuzumab. There were 12 (13.5%) breakthrough reactions, all of which were associated with rituximab and were less severe than the initial reactions. Conclusion: RDD was found to be safe and effective in the largest case series of RDDs with biologics in our country, Turkey.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Rapid Drug Desensitization with Biologics: A Single-Center Experience with Four Biologics

Bavbek

Kendirlinan²,

Çerçi³

et al. 2016

Int Arch Allergy Immunol

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“…Even if evidence is weak and the topic is controversial, whenever possible, ß-blockers and ACE-Inhibitors should be avoided one day prior to desensitization as the former blocks the action of epinephrine and the latter may even aggravate immediate reaction (Aberer et al, 2003;Lebel et al, 2016;Görgülü et al, 2019;Madrigal-Burgaleta et al, 2019;Yang and Castells, 2019).…”

Section: Premedication In Rapid Drug Desensitizationmentioning

confidence: 99%

Rituximab Hypersensitivity: From Clinical Presentation to Management

Fouda

Bavbek

2020

Front. Pharmacol.

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Rituximab is a chimeric monoclonal antibody (mAb) against CD20 molecule which is expressed on human B cells. It has been used for the treatment of various lymphoid malignancies, lymphoproliferative diseases, and rheumatologic disorders. Rituximab is generally well tolerated. However, increased use of rituximab has been associated with hypersensitivity reactions (HSRs), which can be classified as infusion-related, cytokinerelease, type I (IgE/non-IgE), mixed, type III, and type IV reactions. Immediate infusionrelated reactions to rituximab are quite common and decrease in frequency with subsequent infusions. However, in about 10% of patients, severe infusion-related reactions develop, which prevent its use. Some of the immediate infusion reactions are due to a cytokine-release but some reactions raise concerns for type I (IgE/non-IgE) hypersensitivity. Recent studies have shown the presence of serum anti-rituximab antibodies, either represented by the IgG or IgE isotype. In some cases, clinical manifestations of IgE-mediated reactions and cytokine-release reactions partially overlap, which is called a mixed reaction. Classified as Type III reaction, rituximabinduced serum sickness reactions have been reported in patients with autoimmune diseases and hematological malignancies. The classic serum sickness triad (fever, rash, and arthralgia) has been observed in patients mainly with an underlying rheumatologic condition. Severe delayed type IV hypersensitivity reactions including non-severe maculopapular rash to severe reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis have been rarely reported following rituximab injection. Comprehensive reviews focused on rituximab-induced HSRs are scarce. We aimed to review clinical presentations, underlying mechanisms of rituximab hypersensitivity, as well as management including rapid drug desensitization.

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“…A recent publication proved that desensitization is a safe and cost-effective procedure [3]. Desensitization to drugs used in rheumatology such as TNF blockers , rituximab [8,15,18,19,[30][31][32][33][34][35][36][37][38][39][40][41][42], tocilizumab [43][44][45][46][47][48], IL-17 blockers (ixekizumab) [49] and anti-IL-1 (anakinra) [50][51][52][53] has been described. Most of the described procedures were performed in patients with rheumatoid arthritis [8,32] but desensitization in patients with lupus or spondyloarthropathies [24], adult-onset Still disease [43], IgG4-related disease [40] and autoinflammatory disorders [51][52][53] has also been performed with success.…”

Section: Medical Indicationsmentioning

confidence: 99%

Desensitization to biological agents used in rheumatology

Makowska

Lewandowska–Polak

2020

Reumatologia

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Biological agents such as monoclonal antibodies and fusion proteins are widely used for the treatment of patients with various rheumatic disorders, influencing the quality of life, disability and even mortality in patients. However, biological agents can evoke adverse reactions of different grades of severity. Although drug avoidance remains a gold standard in the care of patients hypersensitive to medication, in certain clinical situations the culprit drug is the drug of choice and cannot be replaced by another equally effective compound. In such cases, desensitization can allow the patient to be treated within current guidelines and with the most effective treatment. The authors searched Medline and Scopus databases for English-language sources using the following key words: hypersensitivity, desensitization, biologicals, adalimumab, etanercept, adalimumab, certolizumab, golimumab, rituximab, infliximab, ixekizumab, tocilizumab, anakinra and canakinumab. The aim of our review is to present the current knowledge about desensitization to biological agents and some guidelines according to patient inclusion, contraindications, procedures, and safety requirements. Drug desensitization is a new issue in rheumatology, and the solution to the problem of allergic reactions to biological drugs, which gives patients with rheumatic diseases the opportunity to extend and prolong their therapy. The present article is one of the first widely discussing this topic in the biological treatment of rheumatic diseases.

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Hypersensitivity reactions to rituximab: 53 successful desensitizations in 7 patients with severe, near-fatal reactions

Cited by 10 publications

References 9 publications

Rapid Drug Desensitization with Biologics: A Single-Center Experience with Four Biologics

Rapid Drug Desensitization with Biologics: A Single-Center Experience with Four Biologics

Rituximab Hypersensitivity: From Clinical Presentation to Management

Desensitization to biological agents used in rheumatology

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