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Biologics and anaphylaxis

Sala-Cunill, Annaa,b,c; Luengo, Olgaa,b,c; Cardona, Victoriaa,b,c

Current Opinion in Allergy and Clinical Immunology: October 2019 - Volume 19 - Issue 5 - p 439–446
doi: 10.1097/ACI.0000000000000550
ANAPHYLAXIS AND INSECT ALLERGY: Edited by Gianenrico Senna and Mariana Castells

Purpose of review The use of biologicals as therapeutic agents in oncology and other inflammatory diseases has dramatically increased during the last years. Due to their biological nature and inherent immunological activity, they are able to induce important adverse events, such as cytokine release reactions (rapid release of proinflammatory cytokines), serum sickness disease, and immediate or delayed hypersensitivity reactions, including anaphylaxis. The aim of the current article is to review the state of the art of anaphylaxis because of biological agents.

Recent findings Different phenotypes, and potential underlying endotypes, have been described in anaphylactic reactions to biologicals. There seems to be a spectrum from type 1 reactions (IgE or non-IgE-mediated) to cytokine release reactions, with some reactions falling in between both. Management should be directed according to such phenotypes.

Summary There is ongoing research to further define immediate adverse reactions to biologicals and to find relevant biomarkers to aid in their diagnosis. Such information will serve in defining their immediate and long term management.

aAllergy Section, Department of Internal medicine, Hospital Universitari Vall d’Hebron

bAllery Research Unit, Vall d’Hebron Research Institute, Barcelona, Spain

cARADyAL Research Network, Spain

Correspondence to Victoria Cardona, MD, PhD, Allergy Section, Department of Internal medicine, Hospital Universitari Vall d’Hebron, Ps. Vall d’Hebron 119-129, 08035 Barcelona, Spain. Tel: +34 93 274 6169; e-mail:

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