Drug Allergy pp 369-385 | Cite as


  • Brian A. Baldo
  • Nghia H. Pham


Currently, ~28–30 mAbs are approved or under consideration for approval as specific therapies in the USA or European Union, although about 350 new mAbs for therapeutic application in humans are in the commercial pipeline. So far, the number of target antigens for the mAbs is surprisingly small with more than one of the approved antibodies specific for TNF, HER2, CD20, EGFR, or VEGF. Other specificities include EpCAM, glycoprotein IIb/IIIa, CD30, CD52, C5, α-4 integrin, IgE, IL-6R, BLys, IL-1β, and RANK-L. Initial infusion reactions to some mAbs may provoke tumor lysis syndrome, cytokine release syndrome, and systemic inflammatory response syndrome. Systemic and cutaneous reactions also occur to mAbs. Rituximab, for example, may cause serum sickness, vasculitis, cutaneous reactions, interstitial pneumonitis, and ARDS as well as post-infusion reactions. Some patients receiving cetuximab experienced severe immediate hypersensitivity reactions. The antibodies involved are IgE specific for α-d-galactose-(1–3)-β-d-galactose and reactive with this disaccharide present on the Fab portion of the chimeric antibody. The nature of, and main adverse reactions to, etanercept, the synthetic IFNs pegylated IFNα-2a and pegylated IFNα-2b, IL-2, denileukin diftitox, anakinra, aflibercept, anti-thymocyte globulin, epoetins, and recombinant human insulin are discussed.


Systemic Inflammatory Response Syndrome Darbepoetin Alfa Insulin Lispro Cutaneous Reaction Porcine Insulin 
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Further Reading

  1. Barnes E, Salio M, Cerundolo V, et al. Impact of alpha interferon and ribaviron on the function of maturing dendritic cells. Antimicrob Agents Chemother. 2004; 48:3382–9.PubMedCrossRefGoogle Scholar
  2. Bernardes GJL, Casi G, Trűssel S, et al. A traceless vascular-targeting antibody-drug conjugate for cancer therapy. Angew Chem Int Ed. 2012;51:941–4.CrossRefGoogle Scholar
  3. Cheifetz A, Smedley M, Martin S, et al. The incidence and management of infusion reactions to infliximab: a large center experience. Am J Gastroenterol. 2003;98: 1315–24.PubMedCrossRefGoogle Scholar
  4. Chung CH. Managing premedications and the risk for reactions to infusional monoclonal antibody therapy. Oncologist. 2008;13:725–32.PubMedCrossRefGoogle Scholar
  5. Chung CH, Mirakhur B, Chan E, et al. Cetuximab-induced anaphylaxis and IgE specific for galactose-α-1,3-galactose. N Engl J Med. 2008;358:1109–17.PubMedCrossRefGoogle Scholar
  6. Corren J, Casale TB, Lanier B, et al. Safety and tolerability of omalizumab. Clin Exp Allergy. 2009;39: 788–97.PubMedCrossRefGoogle Scholar
  7. Fleischmann RM, Tesser J, Schiff MH, et al. Safety of extended treatment with anakinra in patients with rheumatoid arthritis. Ann Rheum Dis. 2006; 65:6–12.Google Scholar
  8. Foss FM, Bacha P, Osann KE, et al. Biological correlates of acute hypersensitivity events with DAB389IL-2 (denileukin diftitox, Ontak®) in cutaneous T-cell lymphoma: Decreased frequency and severity with steroid premedication. Clin Lymphoma. 2001;1: 298–302.PubMedCrossRefGoogle Scholar
  9. Hansel TT, Kropshofer H, Singer T, et al. The safety and side effects of monoclonal antibodies. Nat Rev Drug Discov. 2010;9:325–38.PubMedCrossRefGoogle Scholar
  10. Kaneko E, Niwa R. Optimizing therapeutic antibody function: progress with Fc domain engineering. BioDrugs. 2011;25:1–11.PubMedCrossRefGoogle Scholar
  11. Li J, Zhu Z. Research and development of next generation of antibody-based therapeutics. Acta Pharmacol Sin. 2010;31:1198–207.PubMedCrossRefGoogle Scholar
  12. Reichert JM. Which are the antibodies to watch in 2012? MAbs. 2012;4:1–3.PubMedCrossRefGoogle Scholar
  13. Scott AM, Wolchok JD, Old LJ. Antibody therapy of cancer. Nat Rev Cancer. 2012;12:278–87.PubMedCrossRefGoogle Scholar
  14. Senter PD. Potent antibody drug conjugates for cancer therapy. Curr Opin Chem Biol. 2009;13:235–44.PubMedCrossRefGoogle Scholar
  15. Shim H. One target, different effects: a comparison of distinct therapeutic antibodies against the same targets. Exp Mol Med. 2011;43:539–49.PubMedCrossRefGoogle Scholar
  16. Winkler U, Jensen M, Manzke O, et al. Cytokine-release syndrome in patients with B-cell chronic lymphocytic leukemia and high lymphocyte counts after treatment with an anti-CD20 monoclonal antibody (rituximab, IDEC-C2B8). Blood. 1999;94:2217–24.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2013

Authors and Affiliations

  • Brian A. Baldo
    • 1
  • Nghia H. Pham
    • 1
  1. 1.Formerly-Molecular Immunology Unit Kolling Institute of Medical ResearchRoyal North Shore Hospital of SydneySydneyAustralia

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