Hypersensitivity Reactions to Biologicals: from Bench to Bedside

Area of Science:

• Immunology
• Pharmacology
• Clinical Medicine

Background:

• Biologic agents are increasingly used for chronic inflammatory diseases and cancers.
• While effective, biologic agents can cause severe adverse effects, including life-threatening anaphylaxis.
• Distinguishing anaphylaxis from other hypersensitivity reactions (HSR) is crucial for appropriate management.

Purpose of the Study:

• To differentiate anaphylaxis from other HSRs induced by biologic agents.
• To provide a management algorithm for anaphylactic reactions to biologics.
• To guide clinicians in managing hypersensitivity reactions to novel therapeutic agents.

Main Methods:

• Review of published case reports and series on anaphylaxis and HSRs to biologic agents.
• Analysis of clinical presentations of various hypersensitivity reactions.
• Development of a management algorithm based on current literature and clinical practice.

Main Results:

• Anaphylaxis and other HSRs, such as cytokine release syndrome and infusion reactions, are reported with biologic agents.
• Acute management of HSRs depends on clinical presentation.
• Drug desensitization is a key management strategy for subsequent administrations following anaphylaxis.

Conclusions:

• Differentiating anaphylaxis from other immediate HSRs can be challenging, with mixed reactions possible.
• Immediate management involves stopping the infusion, administering adrenaline, antihistamines, and corticosteroids.
• Further diagnostic steps include serum tryptase levels and skin testing for long-term management decisions, such as graded challenge or desensitization.