Naslov
CETUXIMAB-INDUCED ANAPHYLAXIS – THE IMPORTANCE OF MEASURING IMMUNOGLOBULIN E α-GAL: TWO CASEREPORTS

Autori
Đuras, Anamarija ; Horvat, Verica ; Vesar Kocijan, Valentina ; Ostroški, Ivanka ; Rade, Anamarija

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Clin Chem Lab Med 2021 ; 59, Special Suppl / - : Clinical Chemistry and Laboratory Medicine, 2021, M221-M221

Skup
24th IFCC-EFLM European Congress of Clinical Chemistry and Laboratory Medicine (EuroMedlab 2021)

Mjesto i datum
München, Njemačka, 10.04.2022. - 14.04.2022

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
cetuximab ; case report

Sažetak
BACKGROUND-AIM: Cetuximab is a chemotherapeutic drug used for colorectal cancer. Allergic reactions, ranging from mild to severe, even causing anaphylaxis, have been reported. Therefore, it is of utter importance to recognize these allergic reactions in order to prevent anaphylaxis and other severe complications that may end fatally. Cetuximab-specific immunoglobulin E (IgE) directed towards galactose-α-1, 3-galactose (α-Gal) which is part of both Fab segments of cetuximab-specific antibodies, may be found in patients not receiving cetuximab, because of the normal presence of α- Gal in nonprimate mammals tissue. These antibodies are produced after meat consumption that contain glycans, hence causing allergic reactions after cetuximab administration. Hereby we present two cases of cetuximab-induced anaphylaxis from theperiod when specific IgE α-Gal was not routinely measured prior to cetuximab application. METHODS: Two male patients, aged 68 (P1) and 62 years (P2) developed serious complications after cetuximab application. P1 experienced a cardiorespiratory arrest after the first cetuximab application, while P2 developed an anaphylac ticshock after the fifteenth application. Blood samples were drawn few weeks after the anaphylaxis occured, collected in 5-mL serum tubes with clot activator and centrifuged at 3040 g for 10 minutes. Specific IgE α-Gal antibodies(ImmunoCAPTM Specific IgE) were determined by fluoroenzyme immunoassay on the Phadia 100 analyzer (Phadia AB, Uppsala, Sweden). Value of 0.35 kU/L is recommended as the cut-off. RESULTS: Specific α-Gal IgE antibodies were present in serum of both patients. Specifically, for P1 specific IgE α-Gal was 1.34 kU/L ( grade=2), while for P2 specific IgE α-Gal was 6.30 kU/L (grade=3). CONCLUSIONS: Anaphylactic reaction in both patients was caused by the presence of specific α-Gal IgE antibodies. These cases emphasize the importance of measuring cetuximab-specific IgE antibodies prior to drug application, in order to prevent side-effects, which can be life-threatening. Therefore, in our hospital setting, in agreement with physicians, prior to cetuximab application, all patients are tested for the presence of α-Gal IgE antibodies. In the case of an initial negative antibodies result and no signs of allergic reaction, measurement is repeated after the third, sixth, ninth and twelfth cetuximab application. In patients with positive α-Gal IgE antibodies, cetuximab is contraindicated.

Izvorni jezik
Engleski

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