title: Hypersensitivity to biological agents-updated diagnosis, management, and treatment.
abstract: Biological agents are used in the treatment of neoplastic, autoimmune, and inflammatory diseases and their clinical applications are becoming broader. Following their increased utilization, hypersensitivity reactions linked to these drugs have become more frequent, sometimes preventing the use of first-line therapies. The clinical presentation of hypersensitivity reactions to biological agents ranges from mild cutaneous manifestations to life-threatening reactions. In this scenario, rapid desensitization is a groundbreaking procedure that enables selected patients to receive the full treatment dose in a safe way, in spite of their immediate hypersensitivity reaction to the drug, and protects them against anaphylaxis. The aim of this review is to update and discuss some of the main biological agents used in clinical practice (rituximab, trastuzumab, cetuximab, ofatumumab, tocilizumab, brentuximab, omalizumab, and tumor necrosis factor alpha inhibitor agents) and their associated hypersensitivity reactions, including clinical presentations, diagnosis, and treatment in the acute setting. In addition, novel management options with rapid desensitization are presented.
authors.affiliation: Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Medicine, Division of Clinical Immunology and Allergy, University of São Paulo Medical School, São Paulo, SP, Brazil.
authors.forename: Violeta Régnier
authors.initials: VR
authors.lastname: Galvão
authors.affiliation: Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. Electronic address: mcastells@partners.org.
authors.forename: Mariana C
authors.initials: MC
authors.lastname: Castells
mesh_terms: D001685:Biological Factors / Q000009:adverse effects*; D003888:Desensitization, Immunologic; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy; D006801:Humans
chemical_list: D001685:Biological Factors
keywords: Anaphylaxis; Biological agents; Drug allergy; Epinephrine; Hypersensitivity reactions; Monoclonal antibodies; Rapid desensitization; Skin testing; Tryptase