Hane Atsuya, Ito Asami, Ishikura Ken, Imai Hiroshi, Okugawa Yoshinaga
Emergency and Critical Care Center, Mie University Hospital, Mie, JPN.
Department of Genomic Medicine, Mie University Hospital, Mie, JPN.
Cureus. 2022 Jun 26;14(6):e26351. doi: 10.7759/cureus.26351. eCollection 2022 Jun.
Cetuximab is a chimeric mouse-human monoclonal antibody biologic used for the treatment of epidermal growth factor receptor-positive colorectal cancer and head and neck cancer. The incidence of severe anaphylaxis after infusion of cetuximab is a rare but fatal complication. Galactose-α-1,3-galactose (α-gal), a side-chain component in cetuximab, can cause the α-gal syndrome, an allergic cross-reaction to the α-gal contained in mammalian muscle. Here, we report a case of cardiac arrest induced by an anaphylactic reaction from cetuximab infusion. After the initial dosing of cetuximab in an outpatient setting, the patient developed sudden cardiac arrest. Flushing of the skin and bronchoconstriction led to the diagnosis of a severe anaphylactic reaction, whereupon he was treated with repeated doses of epinephrine, steroids, and continuous epinephrine infusion. The patient responded well to initial treatment, leading to a full recovery. The patient's history and subsequent blood tests did not show any meat allergies. As an increasing number of patients receive chemotherapy as outpatients, it is important to be aware of the possibility of severe allergic reactions induced by these drugs.
西妥昔单抗是一种用于治疗表皮生长因子受体阳性的结直肠癌和头颈癌的嵌合型鼠源-人源单克隆抗体生物制剂。输注西妥昔单抗后发生严重过敏反应的情况虽罕见但却是致命的并发症。西妥昔单抗中的一种侧链成分——半乳糖-α-1,3-半乳糖（α-半乳糖），可引发α-半乳糖综合征，这是一种对哺乳动物肌肉中所含α-半乳糖的过敏交叉反应。在此，我们报告一例因输注西妥昔单抗引发过敏反应导致心脏骤停的病例。在门诊环境中首次给予西妥昔单抗剂量后，患者突发心脏骤停。皮肤潮红和支气管收缩导致诊断为严重过敏反应，随后对其多次给予肾上腺素、类固醇药物治疗，并持续输注肾上腺素。患者对初始治疗反应良好，实现了完全康复。患者既往史及后续血液检查均未显示有任何肉类过敏情况。随着越来越多的患者在门诊接受化疗，认识到这些药物引发严重过敏反应的可能性非常重要。
