title: Allergic and nonallergic delayed infusion reactions during natalizumab therapy.
abstract: BACKGROUND
  The monoclonal antibody natalizumab is a novel therapeutic option in the treatment of relapsing forms of multiple sclerosis. In general, therapy with natalizumab is well tolerated. Allergic reactions and acute infusion reactions typically occur during or shortly after infusion, with a peak at the second infusion. Delayed infusion reactions resembling serum sickness-type reactions (type III reaction) are commonly reported in other monoclonal antibody therapies (eg, infliximab and rituximab), but are not described yet for natalizumab.
  
  
  RESULTS
  Delayed infusion reactions occurred in 4 of 40 relapse-remitting multiple sclerosis patients treated with natalizumab.
  
  
  CONCLUSIONS
  Clinicians need to consider the occurrence of infusion reactions, with especially delayed reactions occurring more frequently than previously assumed. Our cases illustrate that some of these infusion reactions may be treated effectively with steroids and reduction of the infusion rate. In cases of antibody-mediated reactions, treatment should be stopped immediately.
authors.affiliation: Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Hellwig
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schimrigk
authors.forename: Malte
authors.initials: M
authors.lastname: Fischer
authors.forename: Aiden
authors.initials: A
authors.lastname: Haghikia
authors.forename: Thomas
authors.initials: T
authors.lastname: Müller
authors.forename: Andrew
authors.initials: A
authors.lastname: Chan
authors.forename: Ralf
authors.initials: R
authors.lastname: Gold
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D001323:Autoantibodies / Q000097:blood; D004342:Drug Hypersensitivity; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed; D007155:Immunologic Factors / Q000009:adverse effects*; D007262:Infusions, Intravenous / Q000379:methods / Q000592:standards; D008775:Methylprednisolone / Q000627:therapeutic use; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D000069442:Natalizumab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D001323:Autoantibodies; D007155:Immunologic Factors; D000069442:Natalizumab; D008775:Methylprednisolone