Rituximab Hypersensitivity: Evaluation, Desensitization, and Potential Mechanisms

Wong, Johnson T.; Long, Aidan A.

doi:10.1016/j.jaip.2017.08.004

Cited by 43 publications

(69 citation statements)

References 32 publications

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“…Reactions are associated with IgE or non-IgE mediated mast cell/basophil degranulation leading to massive histamine, leukotrienes and prostaglandins release. Skin test positivity and/or specific IgE to rituximab is indicative of both IgE-mediated and mixed reactions (Patel and Khan, 2017;Wong and Long, 2017;Isabwe et al, 2018).…”

Section: Cytokine Release Reactionsmentioning

confidence: 99%

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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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Section: Cytokine Release Reactionsmentioning

confidence: 99%

“…It was initially approved as an anti-neoplastic agent (Vikse et al, 2019). Later on, it became a bright treatment opportunity instead of the conventional treatment for chronic granulomatosis and inflammatory diseases (Wong and Long, 2017).…”

Section: Introductionmentioning

confidence: 99%

Rituximab Hypersensitivity: From Clinical Presentation to Management

Fouda

Bavbek

2020

Front. Pharmacol.

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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%

“…Stevens-Johnson syndrome/toxic epidermal necrolysis) and there are no data that those patients can be safely desensitized. Based on this, the expert opinion and recommendation is to avoid desensitization in such cases [4,7,30,55]. • drug-induced organ involvement (hepatitis, nephritis, pneumonitis) [7].…”

Section: Pathomechanism Of the Reaction And Desensitization Possibilitymentioning

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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“…The rate of immunoglobulin E (IgE)–mediated hypersensitivity is approximately 5% to 10% . Although rituximab desensitization protocols have been described, they have not been reported in MG or other neuromuscular disorders . We present two patients with MuSK MG, who received clinical benefit from rituximab but experienced infusion‐related adverse reactions and had no reasonable alternative treatment options.…”

Section: Desensitization Protocol For 1000 Mg Rituximab Dosementioning

confidence: 99%

Rituximab desensitization in two patients with muscle‐specific kinase myasthenia gravis

et al. 2019

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Including antimitochondrial antibodies (AMA) testing in undifferentiated cases of peripheral sensory disorders may improve diagnosis and prognosis in the subset of patients with undiagnosed PBC. AMA positivity can precede the development of hepatic dysfunction in patients with PBC, sometimes by many years, and is exquisitely sensitive and specific for PBC. 7 Antinuclear antibodies (ANA) are often also positive in PBC. However, ANA are less sensitive than AMA for detecting PBC, and a negative ANA result should not preclude AMA testing. 1 The treatment window, therapeutic options, and prognosis of PBC-associated sensory neuronopathy are unknown. Including AMA testing in the assessment of sensory neuronopathies, even if initial liver function testing is normal, can diagnose patients with PBC-associated neurological dysfunction and allow researchers to address these unanswered questions. Early AMA testing will also facilitate prompt treatment with UDCA, which may improve outcomes in early-stage PBC. 1 In summary, we recommend that clinicians exclude PBC with AMA testing when investigating cases of CIDP or neuropathy, even in the absence of hepatic dysfunction. We anticipate that including this widely available, noninvasive test will improve PBC outcomes through earlier diagnosis. Ultimately, this will help us understand the true prevalence and underlying pathophysiology of PBC-associated sensory nerve disorders.

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Rituximab Hypersensitivity: Evaluation, Desensitization, and Potential Mechanisms

Cited by 43 publications

References 32 publications

Rituximab Hypersensitivity: From Clinical Presentation to Management

Rituximab Hypersensitivity: From Clinical Presentation to Management

Desensitization to biological agents used in rheumatology

Rituximab desensitization in two patients with muscle‐specific kinase myasthenia gravis

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