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Hypersensitivity Reactions to Monoclonal Antibodies in Children

Allergy Unit, Meyer Children’s Hospital, 50139 Florence, Italy
SC Pediatria, Ospedale Latisana-Palmanova, Dipartimento Materno-Infantile Azienda Sanitaria Universitaria Friuli Centrale, 33057 Palmanova (UD), Italy
Pediatria, Ospedale San Camillo, 00149 Roma, Italy
UO Allergologia, Dipartimento di Pediatria, Università di Messina, 98124 Messina, Italy
Clinica Pediatrica Policlinico San Matteo, University di Pavia, 27100 Pavia, Italy
Pediatria, Ospedale Principi di Piemonte, 60019 Senigallia, Italy
Pediatria e Neonatologia, Ospedale di Imola, 40026 Imola, Italy
UOC Pediatria, Azienda Ospedaliero-Universitaria “Ospedali Riuniti”, 60020 Ancona, Italy
UOC di Pediatria, Azienda Ospedaliera-Universitaria “Consorziale-Policlinico”, Ospedale Pediatrico Giovanni XXIII, 70123 Bari, Italy
Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
Clinica Pediatrica, Dipartimento Medicina e Chirurgia, Università di Parma, 43126 Parma, Italy
Author to whom correspondence should be addressed.
Medicina 2020, 56(5), 232;
Received: 23 March 2020 / Revised: 28 April 2020 / Accepted: 1 May 2020 / Published: 12 May 2020
(This article belongs to the Special Issue Pediatric Allergy and Immunology)
Biologic drugs are widely used in pediatric medicine. Monoclonal antibodies (mAbs) in particular are a therapeutic option for rheumatic, autoinflammatory and oncologic diseases. Adverse drug reactions and hypersensitivity reactions (HSR) to mAbs may occur in children. Clinical presentation of HSRs to mAbs can be classified according to phenotypes in infusion-related reactions, cytokine release syndrome, both alpha type reactions and type I (IgE/non-IgE), type III, and type IV reactions, all beta-type reactions. The aim of this review is to focus on HSRs associated with the most frequent mAbs in childhood, with particular attention to beta-type reactions. When a reaction to mAbs is suspected a diagnostic work-up including in-vivo and in-vitro testing should be performed. A drug provocation test is recommended only when no alternative drugs are available. In selected patients with immediate IgE-mediated drug allergy a desensitization protocol is indicated. Despite the heavy use of mAbs in childhood, studies evaluating the reliability of diagnostic test are lacking. Although desensitization may be effective in reducing the risk of reactions in children, standardized pediatric protocols are still not available. View Full-Text
Keywords: monoclonal antibodies; biologic drug; drug allergy; hypersensitivity reactions; challenge; desensitization; prick test monoclonal antibodies; biologic drug; drug allergy; hypersensitivity reactions; challenge; desensitization; prick test
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Mori, F.; Saretta, F.; Bianchi, A.; Crisafulli, G.; Caimmi, S.; Liotti, L.; Bottau, P.; Franceschini, F.; Paglialunga, C.; Ricci, G.; Santoro, A.; Caffarelli, C. Hypersensitivity Reactions to Monoclonal Antibodies in Children. Medicina 2020, 56, 232.

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