title: IgE antibodies and skin tests in immediate hypersensitivity reactions to infliximab in inflammatory bowel disease: impact on infliximab retreatment.
abstract: BACKGROUND
  Infliximab (IFX) is used for the treatment of inflammatory bowel diseases (IBD). Immediate hypersensitivity reactions (HR) to IFX are frequently reported.
  
  
  OBJECTIVE
  We investigated immunoglobulin E (IgE)-mediated mechanisms underlying immediate HR to IFX. We also evaluated the clinical utility of allergological tests as well as the tolerability of IFX retreatment in these patients.
  
  
  METHODS
  This was a prospective single-center study including IBD patients with previous immediate HR to IFX. Skin tests to IFX, including prick tests and intradermal tests, and measurement of anti-IFX IgE antibodies were performed at least 4 weeks after HR. In case of negative skin tests and absence of IgE antibodies, readministration of IFX was performed with a twice-reduced infusion rate. In case of positive tests or recurrence of HR during readministration of IFX, a 12-step desensitization or induction of tolerance protocol was proposed.
  
  
  RESULTS
  A total of 24 IBD patients were included (Crohn's disease: n=20). Prick tests to IFX were all negative. Intradermal test was positive in one patient. Anti-IFX IgE antibodies were not detected in 21 patients and were detected in three patients (significant level in one patient and intermediate level in two patients). No relationship was observed between positive skin tests and the presence of anti-IFX IgE antibodies. Switch to adalimumab was well tolerated in 10/11 patients. The readministration of IFX was well tolerated in 4/11 patients. Desensitization to IFX was successful in three out of four patients.
  
  
  CONCLUSIONS
  The vast majority of immediate HR to IFX is not IgE-mediated. Allergological tests are of poor clinical utility. Desensitization or induction of tolerance protocol may allow continuation of IFX therapy in IBD patients with a history of immediate HR.
authors.affiliation: aDepartment of Dermatology and Allergy bInserm U954, Department of Hepato-Gastroenterology cInserm U954, Department of Pediatrics dInserm U-954, NGERE - Nutrition, Genetics, and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre les Nancy, France.
authors.forename: Estelle
authors.initials: E
authors.lastname: Fréling
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.forename: Claire
authors.initials: C
authors.lastname: Poreaux
authors.forename: Alain
authors.initials: A
authors.lastname: Morali
authors.forename: Julie
authors.initials: J
authors.lastname: Waton
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Schmutz
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Guéant
authors.forename: Annick
authors.initials: A
authors.lastname: Barbaud
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000888:Antibodies, Anti-Idiotypic / Q000097:blood* / Q000276:immunology; D002648:Child; D004305:Dose-Response Relationship, Drug; D004361:Drug Tolerance / Q000276:immunology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000139:chemically induced / Q000175:diagnosis / Q000276:immunology*; D007073:Immunoglobulin E / Q000276:immunology*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000276:immunology; D000069285:Infliximab / Q000008:administration & dosage* / Q000009:adverse effects; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D019233:Retreatment; D012882:Skin Tests; D055815:Young Adult
chemical_list: D000888:Antibodies, Anti-Idiotypic; D005765:Gastrointestinal Agents; D007073:Immunoglobulin E; D000069285:Infliximab