1 - Serviço de Imunoalergologia, Centro Hospitalar Universitário de Lisboa Central
- EAACI Hybrid Congress 2022
BACKGROUND. Hypersensitivity reactions (HRs) to monoclonal antibodies (mAbs) may lead to discontinuation of first-line, more effective, treatments. Desensitizations allow the reintroduction of the culprit drug safely. We aim to characterize the patients submitted to desensitization procedures in our Department.
METHODS. We conducted a retrospective analysis of the desensitization procedures to mAbs performed at our Allergy and Clinical Immunology Department from a tertiary hospital in Lisbon, Portugal, from January 2019 to December 2021. All adult patients who underwent a desensitization procedure to mAbs were included. Data regarding the culprit agent, type of reaction leading to desensitization, and safety of desensitization procedures were analysed.
RESULTS. A total of 65 desensitizations to mAbs were performed in 15 patients, with a median (IQR) age of 61 (44-80) years, being 53% (n= 8) male. Oncologic diseases (n=12; 80%) were the main reason for desensitization procedures, being hematologic neoplasms the most frequent ones (n=11), followed by chronic inflammatory diseases (n=3; 20%). The desensitization procedures involved patients with HRs to rituximab (n=11; 73%), anakinra (n=1; 7%), natalizumab (n=1; 7%), ocrelizumab (n=1; 7%), and palbociclib (n=1; 7%). The median (IQR) treatment cycle of occurrence of HR to rituximab was 1 (1-2) cycles. The most common types of reaction were cytokine release reaction (n=9; 60%), type 1 HR (n=3; 20%), and mixed reactions (n=3; 20%). HRs were classified according to Brown’s classification as grade 1 (n=5; 33%), grade 2 (n=6; 40%), and grade 3 (n=4; 27%). Skin tests were performed in five patients (33%): four with HR to rituximab, two (50%) of them positives; and one patient with HR to anakinra, that was positive. All patients received premedication based on the reaction types and severity. Breakthrough reactions occurred in four patients (27%), all in patients with HR to rituximab (n=4/11; 36%). Breakthrough reactions were classified as grade 1 in two patients (50%), as grade 2 in one patient (25%), and as grade 3 in another patient (25%). All patients were successfully desensitized.
CONCLUSION. Drug desensitization procedures to mAbs were safe, allowing all patients with HRs to be managed with a first-line treatment indicated for their disease, reducing the need for an alternative, less effective therapy.
Palavras Chave: dessensibilização, fármacos, hipersensibilidade