title: Adverse reactions to infliximab and the outcome of desensitization.
abstract: BACKGROUND
  Infliximab is a highly effective monoclonal antibody against tumor necrosis factor, which is a major inflammatory mediator in certain gastrointestinal, rheumatic, and skin diseases. In some patients, infliximab infusion causes systemic adverse reactions that often lead to discontinuation of therapy even in responsive patients.
  
  
  OBJECTIVE
  To investigate the frequency and characteristics of adverse reactions to infliximab at the authors' institution and the outcome of their management, including desensitization.
  
  
  METHODS
  This was a single-center retrospective study of patients who were treated with infliximab, primarily for inflammatory bowel disease, from January 1, 2000 to March 31, 2014. Data included age, sex, underlying disease, infliximab therapy duration before the first reaction, manifestation of reaction, onset, and management.
  
  
  RESULTS
  There were 336 patients with inflammatory bowel disease who were treated with infliximab during the study period. Thirty patients (8.9%) developed a systemic adverse reaction to infliximab, which was discontinued in 15 patients (50%) and was continued in 3 patients after premedication and/or decreased infusion rate. Twelve patients (40%) underwent infliximab desensitization with gradually increasing doses starting at a dilution of 0.1 mg/mL to reach the full treatment dose over approximately 4 to 6 hours. It was successful in all 12 patients, who continued to receive up to 26 infliximab infusions, mostly without premedication.
  
  
  CONCLUSIONS
  Infliximab can trigger systemic reactions that hinder its administration. The present desensitization protocol appears to be safe and effective and it can be considered in patients whose inflammatory bowel disease responds well to infliximab but who develop systemic adverse reactions.
authors.affiliation: Allergy and Immunology Section, Louisiana State University Health, Shreveport, Louisiana.
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Mourad
authors.affiliation: Gastroenterology Section, Louisiana State University Health, Shreveport, Louisiana.
authors.forename: Moheb N
authors.initials: MN
authors.lastname: Boktor
authors.affiliation: Allergy and Immunology Section, Louisiana State University Health, Shreveport, Louisiana.
authors.forename: Yesim
authors.initials: Y
authors.lastname: Yilmaz-Demirdag
authors.affiliation: Allergy and Immunology Section, Louisiana State University Health, Shreveport, Louisiana. Electronic address: sbahna@lsuhsc.edu.
authors.forename: Sami L
authors.initials: SL
authors.lastname: Bahna
mesh_terms: D000328:Adult; D000799:Angioedema / Q000139:chemically induced / Q000503:physiopathology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D003424:Crohn Disease / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D003888:Desensitization, Immunologic / Q000379:methods*; D004334:Drug Administration Schedule; D004417:Dyspnea / Q000139:chemically induced* / Q000503:physiopathology; D005260:Female; D005483:Flushing / Q000139:chemically induced / Q000503:physiopathology; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology; D014581:Urticaria / Q000139:chemically induced / Q000503:physiopathology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab