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ALLERGIC REACTION UPON INTRAVITREAL ADMINISTRATION OF ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR AGENTS

Meredith, Gavin G., BS*; Schkade, Paul A., MD; Joondeph, Brian C., MD, MPS*,‡

Retinal Cases and Brief Reports: July 2019 - Volume 13 - Issue 3 - p 287–289
doi: 10.1097/ICB.0000000000000581
Case Report
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Purpose: To describe the patient's allergic response to anti–vascular endothelial growth factor drugs after receiving intravitreal bevacizumab for choroidal neovascularization.

Methods: Clinical case report.

Results: Formal allergy evaluation revealed hypersensitivity to bevacizumab and ranibizumab, but not to pegaptanib or aflibercept.

Conclusion: Bevacizumab and ranibizumab are derivatives of murine monoclonal antibodies, whereas pegaptanib is an aptamer and aflibercept is a fusion protein of human origin. These chemical origins may allow patients to receive pegaptanib or aflibercept despite having allergy to bevacizumab or ranibizumab.

A 62-year-old woman with choroidal neovascularization secondary to presumed ocular histoplasmosis syndrome was treated with bevacizumab and experienced dyspnea, dysphasia, and throat swelling. She underwent an allergy evaluation. Although prick skin testing showed negative results, a graded challenge was positive when challenged with bevacizumab and ranibizumab but not with pegaptanib or aflibercept. This may be explained by the murine origin of the two monoclonal antibody drugs.

*Rocky Vista University College of Osteopathic Medicine, Parker, Colorado;

University of Colorado School of Medicine, Aurora, Colorado; and

Colorado Retina Associates, PC, Denver, Colorado.

Reprint requests: Brian C. Joondeph, MD, MPS, 8101 E Lowry Boulevard, Suite 210, Denver, CO 80230; e-mail: bjoondeph@retinacolorado.com

None of the authors has any financial/conflicting interests to disclose.

© 2019 by Ophthalmic Communications Society, Inc.