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Hypersensitivity to Rituximab in Children.

Giulia Liccioli1, Gabriele Simonini2, Federico Melani3

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Monoclonal antibodies like rituximab can cause hypersensitivity reactions in children. This report details two pediatric anaphylaxis cases linked to rituximab, highlighting the need for allergy investigations.

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Area of Science:

  • Pediatric immunology
  • Pharmacovigilance
  • Clinical allergy

Background:

  • Biological agents, including monoclonal antibodies, are increasingly used in pediatric care.
  • Monoclonal antibodies can elicit hypersensitivity reactions (HR) via various mechanisms, notably IgE-mediated type I reactions.
  • Rituximab (RTX) is a monoclonal antibody used in treating various pediatric conditions.

Observation:

  • This report details two pediatric cases of anaphylaxis to rituximab.
  • Both cases showed positive in vivo allergy tests.
  • One patient presented with an elevated tryptase level, a marker for mast cell activation.

Findings:

  • The observed anaphylaxis cases confirm rituximab as a potential allergen in pediatric patients.
  • Review of literature reveals limited but significant reports of HR to RTX in children.
  • Diagnostic allergy investigations proved crucial in confirming RTX-induced hypersensitivity.

Implications:

  • Accurate diagnosis and management of hypersensitivity reactions to biological agents are critical in pediatric populations.
  • Allergy testing plays a vital role in identifying culprits like rituximab and guiding future treatment strategies.
  • Further research into RTX hypersensitivity in children is warranted to refine diagnostic and therapeutic approaches.