title: Drug-specific Th2 cells and IgE antibodies in a patient with anaphylaxis to rituximab.
abstract: Rituximab (RTX) is currently used in the treatment of lymphoproliferative diseases and of several rheumatologic disorders and is a frequent cause of acute infusion reactions, usually classified as cytokine release syndrome (CRS). Some infusion reactions to RTX raise concern for immediate type I hypersensitivity, even if to date RTX-specific IgE antibodies have not been reported. To improve knowledge of the mechanisms of reactions to RTX, we investigated humoral and cellular immune responses to this drug in a patient suffering from rheumatoid arthritis who displayed two immediate infusion-related reactions. RTX-exposed tolerant patients and healthy untreated subjects were used as controls. Non-isotype-specific and IgE anti-RTX antibodies were positive in the serum samples collected from the reactive patient but not in those from the control groups. Only the reactive patient also displayed skin testing positivity with RTX. More importantly, RTX-stimulated peripheral blood mononuclear cells from the reactive patient, but not from the controls, displayed a dose-dependent proliferative response associated with a Th2 cytokine production profile. Our results show the presence of RTX-specific Th2-type cells and IgE antibodies, thus suggesting that type I hypersensitivity may be an additional mechanism to CRS in the development of RTX reactions.
authors: Immunoallergology Unit, Department of Biomedicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. vultaggioa @ aou-careggi.toscana.it
authors: Alessandra
authors: A
authors: Vultaggio
authors: Andrea
authors: A
authors: Matucci
authors: Francesca
authors: F
authors: Nencini
authors: Sara
authors: S
authors: Pratesi
authors: Giulia
authors: G
authors: Petroni
authors: Daniele
authors: D
authors: Cammelli
authors: Renato
authors: R
authors: Alterini
authors: Luigi
authors: L
authors: Rigacci
authors: Sergio
authors: S
authors: Romagnani
authors: Enrico
authors: E
authors: Maggi
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced* / Q000276:immunology; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000276:immunology; D004306:Dose-Response Relationship, Immunologic; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D056724:Immunity, Humoral; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology*; D008875:Middle Aged; D000069283:Rituximab; D012882:Skin Tests; D018418:Th2 Cells / Q000276:immunology* / Q000473:pathology
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D007073:Immunoglobulin E; D000069283:Rituximab