Successful Desensitization to Cetuximab in a Patient With a Positive Skin Test to Cetuximab and Specific IgE to Alpha-gal

Standards for practical intravenous rapid drug desensitization & delabeling: A WAO committee statement

“…2 Even if most of the RDD experience with cetuximab RDD has involved one-bag protocols, a separate group successfully used this 3bag protocol for cetuximab in a reactive patient who was sensitized to alpha-gal. 143 Interestingly, this patient showed decreased alpha-gal sIgE levels after completing 10 RDD procedures, which could inform future research on the behaviour of biomarkers overtime during RDD. 143 Table 8 features a practical example of the RCUH RDD protocol, and Fig.…”

“…42 Generally, the only apparent limitation, compared with ST to other drugs, seems to be the elevated price of some biologics. 2,5,21,23,25,35,[42][43][44][140][141][142][143][144] However, liaison with Pharmacy can help to minimize costs, for example, by booking patients for ST on a day in which the Pharmacy can use remanents from other vials to make the ST dilutions, or by booking patients for ST on the same day of their DPT or RDD, so that Pharmacy can use a small amount of that material for ST. 2,36 There is a great deal of experience with determining specific IgE (sIgE) to biologics, and the literature shows a good correlation with ST. Unfortunately, their use is limited by the difficulty of access to commercial platforms.…”

“…21,124,140,[145][146][147] Interestingly, cetuximab-reactive patients can be sensitized (even before exposure) to the allergen galactose-alpha-1,3-galactose as part of the "alpha-gal syndrome", and antibodies against this allergen (which can induce DHRs to cetuximab) can be detected by commercial platforms. 143,148,149 There are limited case reports on using the basophil activation test (BAT) to assess reactions to biologics. [150][151][152] Other biomarkers, such as tryptase (for a type I hypersensitivity phenotype) or IL6 (for a cytokine release syndrome), are helpful for endophenotyping.…”

Successful desensitization of a patient with cetuximab hypersensitivity: A case report

“…23 More recently, Garcı´a-Menaya et al reported the successful management of the cetuximab hypersensitivity reaction with a 10-step desensitization protocol in a patient with squamous cell cancer. 24 All the protocols were safe and the aforementioned patients tolerated desensitization well without any reaction or just a minor cutaneous reaction.…”

“…All of these studies are case reports including one or two participants. 19,[22][23][24] In 2008, Jerath et al published the first desensitization protocol for one patient with metastatic breast cancer, who had experienced true IgE-mediated allergy to cetuximab. The five bags, four steps protocol was used for a patient who had been premedicated with prednisolone and diphenhydramine.…”