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Published on: May 4, 2017
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Rituximab Hypersensitivity: Evaluation, Desensitization, and Potential Mechanisms
1Allergy & Immunology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
The Journal of Allergy and Clinical Immunology. in Practice
|November 11, 2017
Summary
Patients with rituximab (Rituxan) hypersensitivity can be successfully desensitized using intravenous protocols. This approach allows continued treatment for lymphoma and other conditions, managing severe reactions effectively.
Area of Science:
- Immunology
- Clinical Pharmacology
- Oncology
Background:
- Rituximab (Rituxan) hypersensitivity reactions (RITS) can be severe, often precluding further treatment.
- Understanding RITS patterns and desensitization protocols is crucial for managing patients requiring rituximab therapy.
Purpose of the Study:
- To analyze patient characteristics, hypersensitivity patterns, and desensitization outcomes in RITS.
- To optimize the management of rituximab hypersensitivity.
Main Methods:
- Retrospective analysis of 25 patients with RITS referred to an Allergy/Immunology Unit.
- Utilized 3 continuous intravenous desensitization protocols based on patient history and reactivity.
- Analyzed clinical reaction patterns and desensitization success rates.
Main Results:
- 23 of 25 patients had lymphoma; 170 desensitizations were performed with high success rates.
- Average hypersensitivity reaction grade decreased significantly from 3.0 to 0.41 post-desensitization.
- Skin test results were not reliable for risk stratification; elevated tryptase indicated reactions.
Conclusions:
- Nearly all patients with severe rituximab hypersensitivity can be successfully desensitized.
- IgE-mediated mechanisms, mast cell degranulation, cytokine release, and tumor lysis syndrome likely contribute to RITS.
- Desensitization enables continued rituximab administration in challenging cases.
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