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

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


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.

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


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


1. Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report--second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Ann Emerg Med. 2006; 47:373–380.
2. Wood RA, Camargo CA Jr, Lieberman P, Sampson HA, Schwartz LB, Zitt M, et al. Anaphylaxis in America: the prevalence and characteristics of anaphylaxis in the United States. J Allergy Clin Immunol. 2014; 133:461–467.
3. Lee SY, Yang MS, Jung JW, Oh MJ, Park CH, Sohn SW, et al. Updates on desensitization for hypersensitivity reactions related to chemotherapy. Allergy Asthma Respir Dis. 2013; 1:295–302.
4. Zanotti KM, Markman M. Prevention and management of antineoplastic-induced hypersensitivity reactions. Drug Saf. 2001; 24:767–779.
5. Jerath MR, Kwan M, Kannarkat M, Mirakhur B, Carey L, Valgus J, et al. A desensitization protocol for the mAb cetuximab. J Allergy Clin Immunol. 2009; 123:260–262.
6. Castells MC, Tennant NM, Sloane DE, Hsu FI, Barrett NA, Hong DI, et al. Hypersensitivity reactions to chemotherapy: outcomes and safety of rapid desensitization in 413 cases. J Allergy Clin Immunol. 2008; 122:574–580.
7. Madrigal-Burgaleta R, Berges-Gimeno MP, Angel-Pereira D, Ferreiro-Monteagudo R, Guillen-Ponce C, Pueyo C, et al. Hypersensitivity and desensitization to antineoplastic agents: outcomes of 189 procedures with a new short protocol and novel diagnostic tools assessment. Allergy. 2013; 68:853–861.
8. Graham J, Muhsin M, Kirkpatrick P. Fresh from the pipeline: cetuximab. Nat Rev Drug Discov. 2004; 3:549.
9. Van Cutsem E, Kohne CH, Hitre E, Zaluski J, Chang Chien CR, Makhson A, et al. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med. 2009; 360:1408–1417.
10. Vermorken JB, Mesia R, Rivera F, Remenar E, Kawecki A, Rottey S, et al. Platinum-based chemotherapy plus cetuximab in head and neck cancer. N Engl J Med. 2008; 359:1116–1127.
11. Kang SP, Saif MW. Infusion-related and hypersensitivity reactions of monoclonal antibodies used to treat colorectal cancer--identification, prevention, and management. J Support Oncol. 2007; 5:451–457.
12. Needle MN. Safety experience with IMC-C225, an anti-epidermal growth factor receptor antibody. Semin oncol. 2002; 29:5 Suppl 14. 55–60.
13. Chung CH, Mirakhur B, Chan E, Le QT, Berlin J, Morse M, et al. Cetuximab-induced anaphylaxis and IgE specific for galactose-alpha-1,3-galactose. N Engl J Med. 2008; 358:1109–1117.
14. Lee JH, Kim JH, Kim TH, Kim SC. Delayed mammalian meat-induced anaphylaxis confirmed by skin test to cetuximab. J Dermatol. 2013; 40:577–578.
15. Naclerio R, Mizrahi EA, Adkinson NF Jr. Immunologic observations during desensitization and maintenance of clinical tolerance to penicillin. J Allergy Clin Immunol. 1983; 71:294–301.
16. Kepley CL. Antigen-induced reduction in mast cell and basophil functional responses due to reduced Syk protein levels. Int Arch Allergy Immunol. 2005; 138:29–39.
17. Castells M, Sancho-Serra Mdel C, Simarro M. Hypersensitivity to antineoplastic agents: mechanisms and treatment with rapid desensitization. Cancer Immunol Immunother. 2012; 61:1575–1584.
18. Chung CH. Managing premedications and the risk for reactions to infusional monoclonal antibody therapy. Oncologist. 2008; 13:725–732.