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Immediate adverse reactions to biologicals: from pathogenic mechanisms to prophylactic management

Vultaggio, Alessandra; Maggi, Enrico; Matucci, Andrea

Current Opinion in Allergy and Clinical Immunology: June 2011 - Volume 11 - Issue 3 - p 262–268
doi: 10.1097/ACI.0b013e3283464bcd
Special commentary

Purpose of review The rapid expansion of the use of biologics has resulted in an increase in adverse drug reactions, some of which can be life-threatening, due to the immunogenicity of these new drugs. This review summarizes the current knowledge of the pathogenic mechanisms of biologics-induced hypersensitivity reactions and highlights the most useful diagnostic and prophylactic tools now available in the clinical management of immunogenicity associated with biologics.

Recent findings Over the last few years, many drug-related or patient-related factors contributing to the immunogenicity of biologics have been identified, thus allowing a better identification of patients at risk of reaction. Recent studies show that different mechanisms sustain hypersensitivity reactions toward biologics, and the application of novel methods for detecting antidrug antibodies has allowed the involvement of specific IgE isotypes. Additionally, experience with procedures of desensitization to biologics continues to grow.

Summary Considering the increased use of the biological therapies in different clinical conditions, the definition of diagnostic and prophylactic strategies represents an unavoidable necessity in the management of potentially reactive patients in order to improve the safety profile of biologics.

aDepartment of Biomedicine, Immunoallergology Unit, Azienda Ospedaliero-Universitaria Careggi, Italy

bCenter for Research, Transfer and High Education DENOTHE, University of Florence, Florence, Italy

Correspondence to Dr Enrico Maggi, Director, Center of Research, Transfer and High Education DENOTHE, University of Florence, Policlinico di Careggi, Viale Morgagni 85, 50134 Firenze, Italy Tel: +39 055 4271049; fax: +39 055 412867; e-mail:

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