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Hypersensitivity Reactions to Monoclonal Antibodies: New Classification and Personalized Management

Published online: March 5, 2018

The use of monoclonal antibodies (mAbs) has increased dramatically and is currently the cornerstone of targeted therapies for cancer and inflammatory diseases. Parallel to the increased use of mAbs, is an increase in hypersensitivity reactions that often prevent the use of first-line therapies for fear of inducing severe hypersensitivity reactions, including anaphylaxis. New subtypes of hypersensitivity reactions have recently been uncovered, which provide better treatment options for patients by improving the management of their reactions through personalized desensitization protocols.

In a recent Research Article published in The Journal of Allergy and Clinical Immunology (JACI) Isabwe and colleagues proposed a novel, evidence-based classification of allergic reaction to mAbs, based on clinical symptoms, their underlying biological mechanisms and biomarkers. Based on the new classification the authors provided recommendations for improved management and desensitization. They analyzed 104 patients undergoing 526 desensitization for 16 different mAbs at the Drug Hypersensitivity and Desensitization Center at Brigham and Women’s Hospital and Dana Farber Cancer Institute.

Four different patterns of reactions were identified: immediate Type I reactions, Cytokine-Release reactions, Mixed reactions (Type I and Cytokine-Release) and delayed Type IV reactions.  Type I reactions were most common during initial reaction, however Cytokine-Release reactions predominated during desensitization. Overall desensitization was found to be the most effective for Type I reactions, with almost all patients completing desensitization regardless of their reaction type. The biomarker interleukin-6 was found to correlate with Cytokine-Release Reactions.

The new classification allows for personalized patient evaluation and permits more accurate assessment of hypersensitivity reactions to mAbs. This approach provides precision management recommendations for desensitization. Desensitization provides a safe and effective re-treatment option allowing patients to remain on culprit mAbs as first line therapy.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.