Akarsu Aysegul, Soyer Ozge, Sekerel Bulent Enis
Department of Pediatric Allergy, Hacettepe University School of Medicine, 06100 Ankara, Turkey.
Curr Treat Options Allergy. 2020;7(1):71-83. doi: 10.1007/s40521-020-00242-2. Epub 2020 Jan 18.
Biologic agents are new treatment options for chronic inflammatory diseases and cancers. As a result of their unique mechanism of action, they are more effective and less toxic treatment option and their clinical usage is increasing. While they are more commonly used, various adverse effects have been observed including life-threatening ones including anaphylaxis. The aim of this review is to distinguish the anaphylaxis from other hypersensitivity reactions (HSR) and provide a management algorithm for the anaphylactic reactions induced by biological agents.
Many case reports and series have been published regarding anaphylaxis and other hypersensitivity reactions (concerning cytokine release syndrome, acute infusion-related reactions) due to biologic agents. Although acute treatment of HSR varies according to the clinical presentation, desensitization with the drug is the major management option for subsequent administrations in the case of anaphylactic reactions.
Anaphylaxis and other immediate onset hypersensitivity reactions are occasionally difficult to differentiate from each other, and mixed-type reactions may be observed. Immediate management of anaphylaxis includes discontinuation of infusion, immediate administration of adrenaline, antihistamines, corticosteroids, and other treatment options depending on the symptoms. After 30-120 min of the reaction, a blood sample for serum tryptase level should be obtained and after 4-6 weeks skin testing with the culprit drug should be performed for decision of long-term management via either graded challenge or desensitization.
生物制剂是慢性炎症性疾病和癌症的新型治疗选择。由于其独特的作用机制，它们是更有效且毒性更小的治疗选择，其临床应用正在增加。虽然它们被更广泛地使用，但已观察到各种不良反应，包括危及生命的过敏反应。本综述的目的是区分过敏反应与其他超敏反应（HSR），并提供生物制剂引起的过敏反应的管理算法。
关于生物制剂引起的过敏反应和其他超敏反应（涉及细胞因子释放综合征、急性输液相关反应），已经发表了许多病例报告和系列研究。虽然HSR的急性治疗根据临床表现而有所不同，但对于过敏反应，药物脱敏是后续给药的主要管理选择。
过敏反应和其他速发型超敏反应有时难以相互区分，可能会观察到混合型反应。过敏反应的即时处理包括停止输液，根据症状立即给予肾上腺素、抗组胺药、皮质类固醇和其他治疗选择。反应发生30 - 120分钟后，应采集血样检测血清类胰蛋白酶水平，4 - 6周后应使用可疑药物进行皮肤试验，以决定通过分级激发或脱敏进行长期管理。
