Galvão Violeta Régnier, Castells Mariana C
Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Medicine, Division of Clinical Immunology and Allergy, University of São Paulo Medical School, São Paulo, SP, Brazil.
Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
J Allergy Clin Immunol Pract. 2015 Mar-Apr;3(2):175-85; quiz 186. doi: 10.1016/j.jaip.2014.12.006.
Biological agents are used in the treatment of neoplastic, autoimmune, and inflammatory diseases and their clinical applications are becoming broader. Following their increased utilization, hypersensitivity reactions linked to these drugs have become more frequent, sometimes preventing the use of first-line therapies. The clinical presentation of hypersensitivity reactions to biological agents ranges from mild cutaneous manifestations to life-threatening reactions. In this scenario, rapid desensitization is a groundbreaking procedure that enables selected patients to receive the full treatment dose in a safe way, in spite of their immediate hypersensitivity reaction to the drug, and protects them against anaphylaxis. The aim of this review is to update and discuss some of the main biological agents used in clinical practice (rituximab, trastuzumab, cetuximab, ofatumumab, tocilizumab, brentuximab, omalizumab, and tumor necrosis factor alpha inhibitor agents) and their associated hypersensitivity reactions, including clinical presentations, diagnosis, and treatment in the acute setting. In addition, novel management options with rapid desensitization are presented.
生物制剂被用于治疗肿瘤、自身免疫性和炎性疾病，其临床应用正在变得更加广泛。随着它们使用的增加，与这些药物相关的超敏反应变得更加频繁，有时会阻碍一线治疗的使用。生物制剂超敏反应的临床表现从轻微的皮肤表现到危及生命的反应不等。在这种情况下，快速脱敏是一种开创性的程序，它能使选定的患者尽管对药物有即刻超敏反应，但仍能以安全的方式接受全治疗剂量，并保护他们免于过敏反应。本综述的目的是更新和讨论临床实践中使用的一些主要生物制剂（利妥昔单抗、曲妥珠单抗、西妥昔单抗、奥法木单抗、托珠单抗、布伦妥昔单抗、奥马珠单抗和肿瘤坏死因子α抑制剂）及其相关的超敏反应，包括急性情况下的临床表现、诊断和治疗。此外，还介绍了快速脱敏的新型管理方案。
