Monoclonal antibodies allergic reactions

All monoclonal antibodies end in the suffix -mab. The syllable before -mab indicates the source of the monoclonal antibody (see Table 85-4). When administering an antibody for the first time, one should consider the source. The less humanized an antibody, the greater is the chance for the patient to have an allergic-type reaction to the antibody. The more humanized the antibody, the lower is the risk of a reaction. The severity of the reactions may range from fever and chills to life-threatening allergic reactions (which have resulted in death). Premedication with acetaminophen and diphenhydramine is common before the first dose of any antibody. If a severe reaction occurs, the infusion should be stopped and the patient treated with antihistamines, corticosteroids, or other supportive measures. 

Omalizumab (Xolair) is the first biological drug approved for the treatment of asthma. Omalizumab is a recombinant humanized monoclonal antibody targeted against IgE. IgE bound to omalizumab cannot bind to IgE receptors on mast cells and basophils, thereby preventing the allergic reaction at a very early step in the process. 

Trastuzumab has dose-dependent pharmacokinetics with a mean t of 5.8 days at the 2-mg/kg maintenance dose. Steady-state levels were achieved between the 16th and the 32nd weeks. The infusion effects of trastuzumab are typical of other monoclonal antibodies and include fever, chills, nausea, dyspnea, and rashes. Allergic reactions also may be observed. Cardiac dysfunction is an unexpected and potentially serious side effect that was observed in the pivotal trial of trastuzumab chemotherapy. Left ventricular dysfunction was seen most commonly in those patients who received doxorubicin and cyclophosphamide. 

Type I allergens are usually considered those macromolecules with the ability to induce specific IgE immune responses and to provoke allergic reactions in sensitized subjects. Antibody-based immunoassays are widely used for the measurement of specific major allergens in the air. Antibodies can originate from sensitized humans, animals (rabbits producing polyclonal antibodies) or fusions of myeloma cells and mouse spleen cells in culture producing monoclonal antibodies. Examples have been published using... 

Two monoclonal antibodies (IgG) were labeled with ferrocene, the first specific to histamine [30], a molecule implicated in allergic reactions, and the second specific to the hormone HCG [31], a glycoprotein biosynthesized by placental tissue throughout pregnancy. This procedure, involving a fraction of their lysine residues, is very similar to that used for triiodothyronine, except for the fact that activation of the ferrocenyl carboxylic acid 7 is achieved by reaction of EDAC and NHSS to give an intermediate N-sulfosuccinimidyl ester (Scheme 8.6). The number of Fc residues attached to the antibodies ranges from 4 to 11. 

Allergic reactions to aU three agents have been described. For etanercept, injection site reactions can occur in up to 20% of patients (287). Some patients develop recall reactions in areas of prior injections (288). More severe reactions, including anaphylactoid reactions, have been reported with infliximab. Up to 20% of patients with infliximab develop infusion reactions. The rate is lower for those patients receiving a concomitant cytotoxic drug such as MTX (289). Infliximab is a chimeric monoclonal antibody. Patients with infusion reactions to infliximab have been successfully treated with the humanized monoclonal antibody adalimumab (278,290). 

Monoclonal antibody therapy rituximab, alemtuzumab Non-specific immunotherapies and adjuvants BCG, interleukin-2 (IL-2), and interferon-a Immunomodulating drugs thalidomide and lenalidomide Cancer vaccines vaccine for advanced prostate cancer Side effects Flu-like symptoms, including fever, chills, nausea, and loss of appetite, allergic reactions, fatigue decrease in blood pressure Work better for some types of cancer than for others... 

Kitani S, Kraft D, Eischler C, Mergenhagen SE, Siraganian RP. Inhibition of allergic reactions with monoclonal antibody to the high affinity IgE receptor [published erratum appears in J Immunol 1988 141(2) 709]. J Immunol 1988 140 2585-2588. 

The bronchospasm that occurs immediately after aeroallergen inhalation in allergic asthmatic subjects is at least partly an IgE-mediated immediate hypersensitivity reaction (1). At least two lines of evidence support this mechanism for the early asthmatic response. Eirst, pretreatment with an anti-IgE monoclonal antibody attenuates the early phase response in asthmatic subjects (Fig. 1) (2,3). Second, analysis of bronchoalveolar lavage fluid collected immediately after air-... 

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