Successful rapid desensitization for cetuximab-induced anaphylaxis

Ha Kyeong Won; Sung Do Moon; Ji Su Shim; Soo Jie Chung; Gun Woo Kim; Su Jeong Kim; Han Ki Park; Hye Ryun Kang

doi:10.4168/aard.2015.3.4.294

Journal List > Allergy Asthma Respir Dis > v.3(4) > 1059115

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Won, Moon, Shim, Chung, Kim, Kim, Park, and Kang: Successful rapid desensitization for cetuximab-induced anaphylaxis

Case Report

Allergy, Asthma & Respiratory Disease 2015; 3(4): 294-296.

Published online: 28 July 2015

DOI: https://doi.org/10.4168/aard.2015.3.4.294

Successful rapid desensitization for cetuximab-induced anaphylaxis

Ha Kyeong Won^1,², Sung Do Moon^1,², Ji Su Shim^1,², Soo Jie Chung^1,², Gun Woo Kim^1,², Su Jeong Kim^2,³, Han Ki Park^1,^2,⁴, Hye Ryun Kang^1,^2,⁴

¹Department of Internal Medicine, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.

²Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.

³Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Korea.

⁴Regional Pharmacovigilance Center, Seoul National University Hospital, Seoul, Korea.

Correspondence to: Hye Ryun Kang. Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. Tel: +82-2-2072-0820, Fax: +82-2-742-3291, helenmed@snu.ac.kr

Received 3 March 2015 Revised 20 May 2015 Accepted 22 May 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Cetuximab, a chimeric mouse-human immunoglobulin, is an antiepidermal growth factor receptor monoclonal antibody. It has been approved by the U.S. Food and Drug Administration for the treatment of metastatic colorectal and head/neck cancer, but can cause fatal hypersensitivity reactions in some patients. A 66-year-old male with metastatic sigmoid cancer had cetuximab-induced anaphylaxis when the first dose of cetuximab was administered. Cetuximab was safely readministered for another 15 cycles based on the rapid desensitization protocol. We experienced a case of cetuximab-induced anaphylaxis on the first exposure which was successfully managed by rapid desensitization.

Keywords: Cetuximab, Hypersensitivity, Immunologic desensitization

Figures and Tables

Table 1

The preparation of 4-bottle tenfold increasing solutions used in the rapid 12-step desensitization protocol in the present case of the cetuximab-induced delayed hypersensitivity

Solution	Concentration (mg/mL)	Rate (mL/hr)	Duration (min)	Dose (mg)	Volume (mL)
1:1,000	0.00169	100	20.0	0.06	33.3
	0.00169	220	15.0	0.09	55.0
	0.00169	480	16.7	0.23	133.7
1:100	0.01708	100	20.0	0.57	33.3
	0.01708	210	15.0	0.90	52.5
	0.01708	450	15.2	1.95	114.2
1:10	0.17235	100	20.0	5.75	33.3
	0.17235	210	15.0	9.05	52.5
	0.17235	450	15.2	19.68	114.2
1:1	1.73913	100	20.0	57.97	33.3
	1.73913	170	15.0	73.91	42.5
	1.73913	300	26.4	229.86	132.2

Notes

This study was supported by a grant from Ministry of Food and Drug Safety to operation of the Regional Pharmacovigilance Center in 2015.

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ORCID iDs: Hye Ryun Kang
https://orcid.org/http://orcid.org/0000-0002-2317-4201
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