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Balan RG, Deleanu DM, Pintea I, Dobrican Baruta CT, Man MA, Bocsan IC, Muntean IA. Managing Severe Adverse Reactions to Biologicals in Severe Asthma. Biomedicines 2023; 11:3108. [PMID: 38137329 PMCID: PMC10740468 DOI: 10.3390/biomedicines11123108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The use of biological agents in the treatment of various inflammatory and malignancy conditions has expanded rapidly. However, these agents can induce hypersensitivity reactions, posing significant clinical challenges. METHODS We conducted a retrospective study that included nine patients with severe asthma who experienced hypersensitivity reactions to biological agents (omalizumab, benralizumab and dupilumab). RESULTS Hypersensitivity reactions to biologicals in severe asthma were observed in 9 of 68 patients treated. In five cases, treatment was stopped or changed to another available biological, and for four patients administered under close surveillance, titrated provocation or desensitization was applied. Successful desensitization was achieved in three of the patients, allowing them to continue therapy without adverse reactions. Improvements in asthma control were observed post-desensitization, leading to the reduced need for systemic steroid treatments and an increase in quality of life. CONCLUSIONS This study highlights the importance of recognizing hypersensitivity reactions to biologicals to have an appropriate approach for patients with severe asthma. As an effective approach for patients experiencing hypersensitivity reactions to biological agents, desensitization allows treatment continuation.
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Affiliation(s)
- Radu-Gheorghe Balan
- Department of Allergology and Immunology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Str. Croitorilor 19–21, 400058 Cluj-Napoca, Romania; (R.-G.B.); (D.M.D.); (I.C.B.); (I.A.M.)
- Department of Science and Technology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540067 Târgu Mureş, Romania
| | - Diana Mihaela Deleanu
- Department of Allergology and Immunology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Str. Croitorilor 19–21, 400058 Cluj-Napoca, Romania; (R.-G.B.); (D.M.D.); (I.C.B.); (I.A.M.)
- Department of Allergology, “Professor Doctor Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
- Department of Internal Medicine, “Professor Doctor Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Irena Pintea
- Department of Allergology and Immunology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Str. Croitorilor 19–21, 400058 Cluj-Napoca, Romania; (R.-G.B.); (D.M.D.); (I.C.B.); (I.A.M.)
- Department of Allergology, “Professor Doctor Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Carmen Teodora Dobrican Baruta
- Department of Allergology and Immunology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Str. Croitorilor 19–21, 400058 Cluj-Napoca, Romania; (R.-G.B.); (D.M.D.); (I.C.B.); (I.A.M.)
- Department of Allergology, “Professor Doctor Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Milena Adina Man
- Department of Medical Sciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
- Department of Pneumology, “Leon Daniello” Clinical Hospital of Pulmonology, 400332 Cluj-Napoca, Romania
| | - Ioana Corina Bocsan
- Department of Allergology and Immunology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Str. Croitorilor 19–21, 400058 Cluj-Napoca, Romania; (R.-G.B.); (D.M.D.); (I.C.B.); (I.A.M.)
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
- Almedo—Allergology and Clinical Immunology Outpatient Clinic, 400394 Cluj-Napoca, Romania
| | - Ioana Adriana Muntean
- Department of Allergology and Immunology, “Iuliu Hațieganu” University of Medicine and Pharmacy, Str. Croitorilor 19–21, 400058 Cluj-Napoca, Romania; (R.-G.B.); (D.M.D.); (I.C.B.); (I.A.M.)
- Department of Allergology, “Professor Doctor Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
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Terao R, Obata R, Okubo A, Aoki S, Azuma K, Ahmed T, Inoda S, Hashimoto Y, Takahashi R, Yoshida H, Misawa M, Takahashi H, Takahashi H. Cytokine profiles in the aqueous humor following brolucizumab administration for exudative age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2023; 261:2465-2476. [PMID: 37000271 DOI: 10.1007/s00417-023-06038-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/05/2023] [Accepted: 03/14/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE To identify the inflammatory cytokine profile in the aqueous humor (AH) of patients with intraocular inflammation (IOI) after intravitreal administration of brolucizumab (IVBr) for neovascular age-related macular degeneration. METHODS Eight eyes from seven patients with IOI after initial IVBr (IVBrIOI +) were enrolled. Sixteen eyes from 16 patients without IOI after IVBr (IVBrIOI -) and aflibercept (IVA) were used as controls. AH samples were analyzed using a multiplex immunoassay. RESULTS C-C motif chemokine ligand (CCL)2, C-X-C motif chemokine ligand (CXCL)1, CXCL10, CXCL13, interleukin (IL)-6, IL-8, IL-10, matrix metalloproteinase (MMP)-1, MMP-9, granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), intercellular adhesion molecule (ICAM)-1, E-selectin, and P-selectin levels were significantly higher in IVBrIOI + than in IVBrIOI - and IVA. Vascular endothelial growth factor (VEGF) was significantly lower in IVBrIOI - compared to that in IVBrIOI + and IVA. In the IVBrIOI + group, there were significant correlations between CCL2, CXCL1, IL-6, IL-8, IL-10, G-CSF, GM-CSF, ICAM-1, and E-selectin, which also exhibited significant correlations in the IVBrIOI - group. CONCLUSION The number of inflammatory cytokines increases during IOI, which is associated with type IV hypersensitivity and vascular inflammation. Some cytokines exhibit correlations even in non-inflamed eyes, indicating a subclinical response to IVBr.
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Affiliation(s)
- Ryo Terao
- Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryo Obata
- Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan.
| | - Atsushi Okubo
- Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Shuichiro Aoki
- Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Keiko Azuma
- Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Tazbir Ahmed
- Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan
| | - Satoru Inoda
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
| | - Yuto Hashimoto
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
| | - Ryota Takahashi
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
| | - Hana Yoshida
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
| | - Manami Misawa
- Department of Ophthalmology, Jichi Medical University, Tochigi, Japan
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Sitek A, Chiarella SE, Pongdee T. Hypersensitivity reactions to biologics used in the treatment of allergic diseases: clinical features, diagnosis and management. FRONTIERS IN ALLERGY 2023; 4:1219735. [PMID: 37637139 PMCID: PMC10450930 DOI: 10.3389/falgy.2023.1219735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023] Open
Abstract
Several monoclonal antibodies have been approved by the Food and Drug Administration (FDA) to treat allergic disorders, including omalizumab, dupilumab, mepolizumab, reslizumab, benralizumab, tralokinumab and tezepelumab, and their indications continue to expand. Although the risks associated with these agents are overall low, hypersensitivity reactions have been described and are reported more frequently with increased use. We provide a comprehensive review of clinical features, diagnosis and management of hypersensitivity reactions attributed to these agents. We aim to provide useful information for the clinician managing hypersensitivity reactions to these monoclonal antibodies, as well as highlight the need for future research to address specific gaps in knowledge.
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Affiliation(s)
- Andrea Sitek
- Division of Allergy, Clinical Immunology and Rheumatology, University of Kansas Medical Center, Kansas, KS, United States
| | | | - Thanai Pongdee
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN, United States
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Sitek AN, Li JT, Pongdee T. Risks and safety of biologics: A practical guide for allergists. World Allergy Organ J 2023; 16:100737. [PMID: 36694621 PMCID: PMC9853370 DOI: 10.1016/j.waojou.2022.100737] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/01/2022] [Accepted: 12/08/2022] [Indexed: 01/18/2023] Open
Abstract
Biologic agents are a rapidly expanding class of medications, and several options are now available for the management of allergic and immunologic disorders. The risks of biologic therapy need to be understood in order to adequately counsel patients and appropriately monitor for potential adverse events. We sought to provide a comprehensive review of the risks and adverse effects reported for the current FDA-approved biologics used in management of allergic and immunologic disorders, including omalizumab, benralizumab, dupilumab, mepolizumab, reslizumab, tezepelumab and tralokinumab. Our review focuses on the risk of hypersensitivity reactions, pregnancy-specific considerations, risk of infection and risk of malignancy. We also highlight drug-specific adverse events and unique safety issues identified in case reports.
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Affiliation(s)
| | | | - Thanai Pongdee
- Corresponding author. Division of Allergic Diseases Mayo Clinic 200 First St SW Rochester, MN 55901
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