CHILDHOOD ANAPHYLAXIS: NEW DEVELOPMENTS IN DIAGNOSIS AND TREATMENT

CHILDHOOD_ANAPHYLAXIS_NEW_DEVELOPMENTS _IN_DIAGNOSIS_AND_TREATMENT_kapak

ANAPHYLAXIS WITH BIOLOGICALS

Işıl Eser Şimşek

Kocaeli University, Faculty of Medicine, Department of Pediatric Immunology and Allergic Diseases, Kocaeli, Türkiye

Eser Şimşek I. Anaphylaxis with Biologicals. In: Harmancı K, editor. Childhood Anaphylaxis: New Developments in Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.149-156.

ABSTRACT

Biologic drugs (BDs) are a diverse category of biotherapeutic product that include monoclonal antibodies (mAb), fusion proteins,cytokines, hormones and vaccines. Dramatically increasing use of BDs has led to an increase in the anaphylaxis to these drugs. Recently, in the classification based on phenotype, endotype and biomarkers, the mechanisms responsible for anaphylactic reactions caused by these drugs have been shown as Type 1 (IgE/Non IgE), cytokine release reactions (CSR) and their combination (mixed reactions). While type I reactions typically occur after at least one previous administration, CRRs may occur at first the first known administration and usually quickly disappear with repeated exposures. Apart from the clinical story, if available, performing skin tests (ST) such as prick test and intradermal test (IDT), in vitro assays and drug provocations will assist the allergists to identifying the underlying mechanism the reaction. The skin test positivity and increased tryptase level will help to distinguish Type I reactions from the CRRs, while IL-6 elevation is most closely associated with CRRs. Rapid drug desensitization (RDD) should be performed in the patient with positive ST to BD, regardless of the grade of the reaction. If the reaction is mild and skin test result is negative, it is recommended to administer the culprit BD by drug provocation test (DPT). If the DPT is positive, the patient should receive the responsible drug with RDD; whereas if the DPT is negative, the patient can switch to regular infusions.

Keywords: Biological drugs; Anaphylaxis; Drug hypersensitivity; Cytokine release syndrome

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