Utilizing Biologics in Drug Desensitization

Abstract

Purpose of Review The purpose of this literature review was to review the latest advancements with biologics in rapid drug desensitization. Our methodology was to highlight both desensitization to biologics themselves and the use of biologics in desensitization to both biologic and nonbiologic drugs. Recent Findings Biologics are a vast category of drugs that include monoclonal antibodies, nanobodies, modern vaccinations, and even hormones. Desensitization to biologics can be safely performed through standardized procedure. Biomarkers are used both in vitro and in vivo to help identify and classify hypersensitivity reactions. Hypersensitivity reactions to the mRNA vaccinations against SARS-CoV-2 present their own unique challenges to management. There are specific excipients in monoclonal antibodies that are thought to be responsible for many of their hypersensitivity reactions. Certain biologics can even be used to assist in desensitization to other drugs. Summary Rapid drug desensitization is a standardized procedure that may be able to help many patients who have experienced hypersensitivity reactions to biologics and would best be treated with them to continue to receive them. Biologic drugs have opened a new era in medicine for the prevention and treatment of infectious diseases, cancer, and inflammatory diseases. Hypersensitivity reactions to biologics are quite common. This literature review presents the latest advancements in our understanding of hypersensitivity reactions to biologics, how rapid drug desensitization can be used to continue therapy despite history of hypersensitivity, and how biologics themselves can be used to aid in desensitization itself.

Desensitization in children allergic to drugs: Indications, protocols, and limits

“…10 Signs and symptoms arise because of the release of inflammatory cytokines such as tumor necrosis factor-alpha and IL-6, with the latter being a major biomarker for this type of HSR. 11 These reactions are well described with taxane agents and monoclonal antibodies (mAbs). 12 • Mixed reactions: occur as a mixture of IgE and CRS, are typically observed with chemotherapy and/or mAbs, and may also be successfully managed with DDS.…”

“…Clinical presentation can vary from the more common mild fever, chills, back pain, arthralgia, myalgia, nausea, vomiting, headache and rash to rare and severe life‐threatening multiorgan failure, hypotension, hypoxia, heart, renal or liver failure, disseminated intravascular coagulopathy, and neurologic dysfunction 10 . Signs and symptoms arise because of the release of inflammatory cytokines such as tumor necrosis factor‐alpha and IL‐6, with the latter being a major biomarker for this type of HSR 11 . These reactions are well described with taxane agents and monoclonal antibodies (mAbs) 12 …”

Serum tryptase and drug hypersensitivity: why, how and what? A systematic review

“…Other forms of immediate drug hypersensitivity have been described, most notably the cytokine release syndrome, which is not related to mast cell activation [7]. In this case, serum tryptase does not exhibit the typical transient increase and provides only indirect diagnostic evidence, that is lack of evidence for a mast cell-induced mechanism, while cytokine biomarkers, such as serum IL-6, help identify an endotype-phenotype connection and hold promising diagnostic performance [ 4].…”

“…& ,19-21]. Patients with bST of 8 mg/l or higher even on a single blood sample should be genotyped for HaT, a condition associated with increased risk for systemic hypersensitivity reactions including drug hypersensitivity [7,20,[22][23][24]. Drug hypersensitivity was identified in 30 out of 58 of anaphylaxis events in a HaT cohort [25].…”

“…mast cell mediated) and nonimmediate hypersensitivity (e.g. T lymphocyte-mediated delayed skin reactions) [3 providing guidance for multiple clinical and biomarker pictures of drug hypersensitivity [7].…”