Current Knowledge and Management of Hypersensitivity Reactions to Monoclonal Antibodies

Hypersensitivity reactions (HSRs) to monoclonal antibodies (mAbs) are increasingly frequent as this class of therapeutic agents is rapidly expanding. Immediate and nonimmediate HSRs have been reported with mAbs. Immediate HSRs can be explained by 3 main mechanisms: cytokine release syndrome, IgE-mediated, and IgG-mediated reactions. Importantly, IgE-mediated reactions can occur on first exposure due to preformed specific IgEs, as shown for cetuximab. Almost all patients with an immediate HSR can be safely re-exposed either through desensitization or challenge depending on the severity and mechanism of the initial reaction. An algorithm detailing the general approach to these HSRs and the preferred method of re-exposure is presented in this review. Also, the mAbs that are most frequently implicated in HSRs are discussed individually.