Hypersensitivity reactions to biological agents with special emphasis on tumor necrosis factor-alpha antagonists.
OBJECTIVE
Several biological agents have been introduced into the drug market and more are emerging. Adverse reactions to these agents have recently been classified into five different subtypes. Some of these reactions are frequent but without consequences for the patients. Others are less frequent but potentially life-threatening, and they include allergic reactions.


RESULTS
Hypersensitivity reactions are well described adverse drug reactions, corresponding to the ss-type of the newly proposed classification of adverse reactions induced by biological agents. We focus our search on tumor necrosis factor-alpha antagonists, as they represent a dramatic improvement in the therapy of both rheumatic and inflammatory bowel diseases and because adverse reactions have been closely scrutinized. We also add cases from our own experience. We found very few properly documented allergic reactions.


CONCLUSIONS
Hypersensitivity reactions to tumor necrosis factor-alpha antagonists are not rare. Whether these manifestations have to be considered type beta or type gamma reactions is still a matter of debate. There is a need for allergological tests in vivo and in vitro.
Campi
Paolo
P
Allergy and Clinical Immunology Unit, Nuovo Ospedale San Giovanni di Dio, Florence, Italy.
Benucci
Maurizio
M
Manfredi
Mariangela
M
Demoly
Pascal
P
D000068879:Adalimumab; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000276:immunology; D000906:Antibodies / Q000032:analysis; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000276:immunology; D061067:Antibodies, Monoclonal, Humanized; D001688:Biological Products / Q000009:adverse effects / Q000276:immunology; D004342:Drug Hypersensitivity / Q000276:immunology; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects* / Q000276:immunology; D000069285:Infliximab; D018124:Receptors, Tumor Necrosis Factor / Q000276:immunology; D011994:Recombinant Proteins / Q000009:adverse effects / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000893:Anti-Inflammatory Agents; D000906:Antibodies; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D001688:Biological Products; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D011994:Recombinant Proteins; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept