Department of Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts.
Department of Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts.
Ann Allergy Asthma Immunol. 2019 Jul;123(1):35-41. doi: 10.1016/j.anai.2019.04.015. Epub 2019 Apr 25.
To review the medical literature on hypersensitivity reactions to therapeutic monoclonal antibodies for patients with malignant tumors and chronic inflammatory or connective tissues diseases.
We searched the PubMed database using the terms monoclonal antibody, hypersensitivity, and allergy.
We selected case reports and cohort studies of patients with hypersensitivity reactions to monoclonal antibodies. We included selected review articles to glean expert opinion on issues for which high-quality data are available. We sought specific information on the incidence, clinical description, pathobiology, and treatment of reactions.
Hypersensitivity reactions to therapeutic monoclonal antibodies can be classic type I (mast cell mediated, perhaps IgE dependent) reactions, cytokine release reactions, or type IV cell-mediated reactions. There are limited data on the frequency of such reactions, and because new agents are added to the set at a relatively high rate, it is difficult to determine precisely the incidence of reactions to this class of drugs as a whole. The classification of a specific hypersensitivity reaction depends mainly on the medical history. Skin testing may be available but often is not validated and may be prohibitively expensive. Avoidance of the culpable agent is ideal, but if treatment with the responsible drug is necessary, rapid drug desensitization is an option for type I reactions. Desensitization is less likely to be effective for cytokine release reactions and is contraindicated for type IV reactions.
Hypersensitivity reactions to therapeutic monoclonal antibodies are heterogeneous. Management depends on accurate identification and thoughtful consideration of the pathobiologic features of the reaction.
综述治疗恶性肿瘤及慢性炎症或结缔组织疾病患者的治疗性单克隆抗体过敏反应的医学文献。
我们使用术语“单克隆抗体、过敏反应和过敏”在 PubMed 数据库中进行检索。
我们选择了单克隆抗体过敏反应患者的病例报告和队列研究。我们纳入了精选的综述文章，以获取高质量数据可获得的问题的专家意见。我们寻求有关反应发生率、临床描述、病理生物学和治疗的具体信息。
治疗性单克隆抗体的过敏反应可能是经典的 I 型（肥大细胞介导，可能 IgE 依赖性）反应、细胞因子释放反应或 IV 型细胞介导的反应。此类反应的频率数据有限，并且由于新制剂以相对较高的速度添加到该类药物中，因此很难准确确定此类药物作为一个整体的反应发生率。特定过敏反应的分类主要取决于病史。皮肤试验可能可用，但通常未经验证且可能非常昂贵。避免罪魁祸首是理想的，但如果需要用有责任的药物治疗，则 I 型反应是快速药物脱敏的选择。脱敏不太可能对细胞因子释放反应有效，并且对 IV 型反应禁忌。
治疗性单克隆抗体的过敏反应是异质的。管理取决于反应的病理生物学特征的准确识别和深思熟虑的考虑。
