A new pediatric protocol for rapid desensitization to monoclonal antibodies

Int Arch Allergy Immunol. 2014;165(3):214-8. doi: 10.1159/000369299. Epub 2014 Dec 20.

Abstract

Monoclonal antibodies are important therapeutic tools, but their usefulness may be limited when patients experience acute hypersensitivity reactions. Patients reporting a history of adverse allergic reaction are likely to discontinue their therapeutic protocol or be switched to an alternative drug, which is sometimes less effective than that originally prescribed. Drug desensitization has proven to be a highly effective strategy to readminister a drug in a patient who has experienced a hypersensitivity reaction. It involves forcing the patient's immune system to accept and tolerate the allergen. Nevertheless, such a procedure is still empiric for monoclonal antibodies and not common in the pediatric population. The aim of our study is to demonstrate the clinical success of a new protocol of rapid desensitization to infliximab in a pediatric patient affected by ulcerative colitis, who developed an anaphylaxis to the drug. We used a protocol of rapid desensitization consisting of 13 steps, with the first being 1/1,000,000 of the cumulative and total dose. Such a protocol has proven to be able to induce a temporary tolerance to infliximab, allowing the patient to achieve complete control of his disease.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Allergens / immunology
  • Anaphylaxis / etiology
  • Anaphylaxis / prevention & control*
  • Antibodies, Monoclonal / administration & dosage*
  • Antibodies, Monoclonal / adverse effects
  • Antibodies, Monoclonal / immunology
  • Clinical Protocols
  • Colitis, Ulcerative / complications
  • Colitis, Ulcerative / drug therapy*
  • Desensitization, Immunologic / methods*
  • Drug Hypersensitivity / complications
  • Drug Hypersensitivity / drug therapy*
  • Feasibility Studies
  • Humans
  • Immune Tolerance
  • Infliximab

Substances

  • Allergens
  • Antibodies, Monoclonal
  • Infliximab