Hypersensitivity and Immune-related Adverse Events in Biologic Therapy

Waldron, Jamie; Schworer, Stephen; Kwan, Mildred

doi:10.1007/s12016-021-08879-w

Cited by 9 publications

(6 citation statements)

References 147 publications

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“… 101 While globally, the immediate hypersensitivity response rate to cetuximab was less than 3%, studies of patients in the southeastern US who received this biological product revealed hypersensitivity reactions as high as 22%. 52 , 101 , 102 Cetuximab is synthesized in a mouse-derived myeloma SP2/0 cell line that glycosylates the monoclonal antibody with alpha-gal. 103 In the southern US, areas with large tick populations have been associated with higher rates of cetuximab anaphylaxis, 67 , 104 since lone star tick exposure is linked to the development of the preformed alpha-gal specific IgE driving immediate hypersensitivity reactions to the alpha-gal on cetuximab.…”

Section: Clinical Implications Of Alpha-gal Syndromementioning

confidence: 99%

The Meat of the Matter: Understanding and Managing Alpha-Gal Syndrome

Macdougall¹,

Thomas²,

Iweala³

2022

ITT

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Alpha-gal syndrome is an unconventional food allergy, characterized by IgE-mediated hypersensitivity responses to the glycan galactose-alpha-1,3-galactose (alpha-gal) and not to a food-protein. In this review, we discuss how alpha-gal syndrome reframes our current conception of the mechanisms of pathogenesis of food allergy. The development of alpha-gal IgE is associated with tick bites though the possibility of other parasites promoting sensitization to alpha-gal remains. We review the immune cell populations involved in the sensitization and effector phases of alpha-gal syndrome and describe the current understanding of why allergic responses to ingested alpha-gal can be delayed by several hours. We review the foundation of management in alpha-gal syndrome, namely avoidance, but also discuss the use of antihistamines, mast cell stabilizers, and the emerging role of complementary and alternative therapies, biological products, and oral immunotherapy in the management of this condition. Alpha-gal syndrome influences the safety and tolerability of medications and medical devices containing or derived from mammalian products and impacts quality of life well beyond food choices.

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Section: Clinical Implications Of Alpha-gal Syndromementioning

confidence: 99%

The Meat of the Matter: Understanding and Managing Alpha-Gal Syndrome

Macdougall¹,

Thomas²,

Iweala³

2022

ITT

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“…Appropriate drug desensitization can be performed for patients when there is no other option to control the disease. 34 , 35 …”

Section: Resultsmentioning

confidence: 99%

Iranian Consensus Guideline for Pharmacotherapy with Biologics and Small Molecules Drugs in Adults with Inflammatory Bowel Diseases

Khoshnam‐Rad

Vahedi

Sadeghi

et al. 2023

Middle East J Dig Dis

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Background: Pharmacotherapy with biologics and small molecules, as the more effective therapies for moderate to severe ulcerative colitis (UC) and Crohn’s disease (CD), is complex. Choosing the best methods for their utilization in order to induce and maintain remission are critical for practicing gastroenterologists. We aimed to develop an Iranian consensus on the management of inflammatory bowel disease (IBD) patients with biologics and small molecules. Methods: A Delphi consensus was undertaken by experts who performed a literature summary and voting process. Quality of evidence was assessed using the Grading and Recommendations Assessment, Development, and Evaluation; and an additional risk of bias-protocol. Results: Following an extensive search of the literature, 219 studies were used to determine the quality of the evidence. After three rounds of voting, consensus (defined as≥80% agreement) was reached for 87 statements. Conclusion: We considered different aspects of pharmacotherapy in this consensus. This guideline, along with clinical judgment, can be used to optimize management of IBD patients.

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“…Polymorphic ventricular tachycardia has also been reported with rituximab infusion [ 57 ]. CRS manifestations include fever, hypotension, and hypoxia, and management includes anti-pyretics, corticosteroids, and supportive care for organ failure [ 58 ]. Rare, delayed IRRs, including Stevens-Johnson syndrome, toxic epidermal necrolysis, and serum-sickness like reactions can also occur [ 58 ].…”

Section: Targeted Antibodiesmentioning

confidence: 99%

“…CRS manifestations include fever, hypotension, and hypoxia, and management includes anti-pyretics, corticosteroids, and supportive care for organ failure [ 58 ]. Rare, delayed IRRs, including Stevens-Johnson syndrome, toxic epidermal necrolysis, and serum-sickness like reactions can also occur [ 58 ]. The preoperative history and physical (H&P) should note the date of last targeted mAB infusion, incidence and severity of IRRs, and treatment received for IRRs and consider sequalae of IRRs and their treatment in the perioperative period (i.e., organ failure, hyperglycemia from corticosteroid administration).…”

Section: Targeted Antibodiesmentioning

confidence: 99%

Cancer Immunotherapies: What the Perioperative Physician Needs to Know

et al. 2022

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Purpose of ReviewFor patients with cancer, treatment may include combination therapy, including surgery and immunotherapy. Here, we review perioperative considerations for the patient prescribed immunotherapeutic agents. Recent Findings The perioperative period is a poignant moment in the journey of a patient with cancer, potentially deemed most influential compared to other moments in the care continuum. Several immunotherapeutic medications have been employed near the time of surgery to potentially increase effectiveness. Of the various drug classes, including immune checkpoint inhibitors, cytokines, toll-like receptor agonists, and oncolytic viruses, among others, several notable immunerelated adverse effects were noted. They range from minor effects to more serious ones, such as renal failure, myocarditis, and tumor growth. Summary Surgery and immunotherapy are often employed in combination for primary treatment and prevention of cancer recurrence. Careful review and consideration of the pharmacokinetics, pharmacodynamics, and toxicities of immunotherapy benefit the perioperative physician and their patients.

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Hypersensitivity and Immune-related Adverse Events in Biologic Therapy

Cited by 9 publications

References 147 publications

The Meat of the Matter: Understanding and Managing Alpha-Gal Syndrome

The Meat of the Matter: Understanding and Managing Alpha-Gal Syndrome

Iranian Consensus Guideline for Pharmacotherapy with Biologics and Small Molecules Drugs in Adults with Inflammatory Bowel Diseases

Cancer Immunotherapies: What the Perioperative Physician Needs to Know

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