Related Experiment Video
Updated: Mar 17, 2026
Detection and Quantification of Calcitonin Gene-Related Peptide CGRP in Human Plasma Using a Modified Enzyme-Linked Immunosorbent Assay
Published on: June 16, 2023
Delayed urticaria during treatment with anti-CGRP monoclonal antibodies in migraine
Christoph T Berger1,2,3, Federico Burguet Villena3,4, Severin B Vogt5
1University Center for Immunology, University Hospital Basel, Basel, Switzerland.
Objective:
To characterize clinical presentation and management of urticaria associated with calcitonin gene-related peptide (CGRP) -targeting monoclonal antibodies (mAbs) for migraine prophylaxis.
Background:
CGRP-targeting mAbs are effective in migraine prophylaxis, but have been associated with hypersensitivity reactions, including urticaria. The underlying mechanisms, risk factors, and therapeutic consequences of these anti-CGRP mAb-related hypersensitivity reactions remain poorly understood.
Methods:
We performed a retrospective case series with descriptive analysis on five patients who developed urticaria after anti-CGRP mAb administration. Timing of reactions, history of urticaria, re-exposure strategies including premedication, and clinical outcomes were analyzed by chart review.
Results:
Urticaria occurred after the first injection in three patients and after the third or sixth injection in two. Onset was delayed (12-48 h) in all patients, indicating a non-IgE-mediated hypersensitivity. Four of five patients had a prior history of urticaria. All patients were re-exposed: two to the same anti-CGRP mAb and three to a different. Three patients received H1-antihistamine premedication. All premedicated patients in this series tolerated re-exposure, irrespective of switching. One patient experienced worsening urticaria with repeated dosing without premedication despite negative allergy testing, but later tolerated the same anti-CGRP mAb with premedication. In contrast, urticaria or angioedema recurred in two patients who switched anti-CGRP mAb without premedication. One subsequently tolerated rimegepant.
Conclusion:
Anti-CGRP mAb-associated urticaria in this case series was delayed and likely non-immunoglobulin E (non-IgE)-mediated. Our experience supports that in selected patients with delayed urticaria, individualized management, including H1 antihistamine premedication, may allow continuation of effective migraine prophylaxis. Larger cohorts are needed to identify risk factors and to inform general management recommendations.
Related Concept Videos
01:20Myasthenia Gravis: Overview and Treatment
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
01:29Hypersensitivity Reactions: Delayed Hypersensitivity Reactions
01:26Cholinergic Antagonists: Therapeutic Uses
Respiratory Tract: Ipratropium, aclidinium, and tiotropium treat asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). They protect against bronchoconstriction caused by irritants like cigarette smoke, sulfur dioxide, and ozone. They also help reduce nasopharyngeal...
01:28Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists
01:25Antiasthma Drugs: Mast Cell Stabilizers and Anti-IgE Drugs
Mast cell stabilizers, such as cromolyn (also known as sodium cromoglycate) and nedocromil (Tilade), are effective drugs in asthma management. These stabilizers hinder histamine release by skillfully obstructing the activation of mast cells and other cellular entities. Notably, they navigate this task without...
01:01Hypersensitivity Reactions: Cytolytic Reactions