Successful administration of omalizumab by desensitization protocol following systemic reactions in 12 patients

Bernaola, Marta; Hamadi, Sahar; Lynch, Donna‐Marie; Marquis, Kathleen A.; Silver, Jared; Castells, Mariana; Hsu, Joyce T.

doi:10.1016/j.jaip.2020.11.066

Cited by 12 publications

(10 citation statements)

References 9 publications

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“…Increased serum levels of IL-6 were associated with oxaliplatin CRRs and Mx and correlated with the severity of reactions (Table 2B). While the cellular origin has and bags adjustments, omalizumab may be helpful for type I, [30][31][32][33] while the use of tocilizumab, which blocks IL-6, may be helpful for CRRs 34 (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

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Differential presentation of hypersensitivity reactions to carboplatin and oxaliplatin: Phenotypes, endotypes, and management with desensitization

Jimenez‐Rodriguez,

de las Vecillas,

Labella

et al. 2023

Allergy

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BackgroundDrug hypersensitivity reactions (DHRs) to platinum‐based drugs are heterogenous and restrict their access, and drug desensitization (DD) has provided a ground‐breaking procedure for their re‐introduction, although the response is heterogeneous. We aimed to identify the phenotypes, endotypes, and biomarkers of reactions to carboplatin and oxaliplatin and their response to DD.MethodsSeventy‐nine patients presenting with DHRs to oxaliplatin (N = 46) and carboplatin (N = 33) were evaluated at the Allergy Departments of two tertiary care hospitals in Spain. Patient symptoms, skin testing, biomarkers, and outcomes of 267 DDs were retrospectively analyzed.ResultsOxaliplatin‐reactive patients presented with type I (74%), cytokine release reaction (CRR) (11%), and mixed (Mx) (15%) phenotypes. In contrast, carboplatin reactive patients presented with predominantly type I (85%) and Mx (15%) but no CRRs. Out of 267 DDs, breakthrough reactions (BTRs) to oxaliplatin occurred twice as frequently as carboplatin (32% vs. 15%; p < .05). Phenotype switching from type I to another phenotype was observed in 46% of oxaliplatin DDs compared to 21% of carboplatin DDs. Tryptase was elevated in type I and Mx reactions, and IL‐6 in CRR and Mx, indicating different mechanisms and endotypes.ConclusionCarboplatin and oxaliplatin induced three different types of reactions with defined phenotypes and endotypes amendable to DD. Although most of the initial reactions for both were type I, oxaliplatin presented with unique CRR reactions. During DD, carboplatin reactive patients presented mostly type I BTR, while oxaliplatin‐reactive patients frequently switched from type I to CRR, providing a critical difference and the need for personalized DD protocols.

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Section: Discussionmentioning

confidence: 99%

“…Future studies are needed to evaluate the safety of starting DD for CRR reactions with reduced number of bags. For patients with high risk DD refractory to premedication and bags adjustments, omalizumab may be helpful for type I, 30–33 while the use of tocilizumab, which blocks IL‐6, may be helpful for CRRs 34 (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

Differential presentation of hypersensitivity reactions to carboplatin and oxaliplatin: Phenotypes, endotypes, and management with desensitization

Jimenez‐Rodriguez,

de las Vecillas,

Labella

et al. 2023

Allergy

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“…When considering biologics used for allergic diseases, published data for desensitization procedures is limited to omalizumab ( 41 – 44 ), which does have a black box warning for risk of anaphylaxis. The largest cohort reported that underwent desensitization for omalizumab includes 12 patients, four of whom experienced reactions upon first exposure.…”

Section: Desensitization Protocols For Biologicsmentioning

confidence: 99%

Hypersensitivity reactions to biologics used in the treatment of allergic diseases: clinical features, diagnosis and management

2023

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Several monoclonal antibodies have been approved by the Food and Drug Administration (FDA) to treat allergic disorders, including omalizumab, dupilumab, mepolizumab, reslizumab, benralizumab, tralokinumab and tezepelumab, and their indications continue to expand. Although the risks associated with these agents are overall low, hypersensitivity reactions have been described and are reported more frequently with increased use. We provide a comprehensive review of clinical features, diagnosis and management of hypersensitivity reactions attributed to these agents. We aim to provide useful information for the clinician managing hypersensitivity reactions to these monoclonal antibodies, as well as highlight the need for future research to address specific gaps in knowledge.

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“…Typically, medications are avoided after hypersensitivity reactions unless there is no alternative treatment and there is an excellent clinical response to omalizumab previously. There are some prior reports of omalizumab administration by desensitization protocol after acute or delayed reactions using a desensitization protocol with a pathway for possible return to standard injection [28].…”

Section: Introductionmentioning

confidence: 99%

Biologics as treatment options for anaphylaxis

Cafarotti

Fiocchi

Arasi

2021

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewTo provide the most recent insights in the use of biologicals in the treatment of patients with anaphylaxis.Recent findingsThere is evidence that biologics such as omalizumab may be safe and effective in preventing anaphylactic reactions in patients at high risk mainly because of severe food allergy or desensitization procedures to food, airborne allergen, drugs, or hymenoptera venom.SummaryFurther knowledge will guide the adoption and implementation of any new therapy including biologics for anaphylaxis according to the stratification of risk/benefits.

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Successful administration of omalizumab by desensitization protocol following systemic reactions in 12 patients

Cited by 12 publications

References 9 publications

Differential presentation of hypersensitivity reactions to carboplatin and oxaliplatin: Phenotypes, endotypes, and management with desensitization

Differential presentation of hypersensitivity reactions to carboplatin and oxaliplatin: Phenotypes, endotypes, and management with desensitization

Hypersensitivity reactions to biologics used in the treatment of allergic diseases: clinical features, diagnosis and management

Biologics as treatment options for anaphylaxis

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