Rapid Desensitisation for the Management of Hypersensitivity Reaction to Biologicals: Infliximab and Adalimumab in Inflammatory Bowel Disease Patients

| Allergy & Immunology
*Bronislava Novotna,1 Libuse Prochazkova,2 Hana Smerkova,3 Vladimir Zboril,4 Lucie Prokopova,4

The authors have declared no conflicts of interest.

EMJ Allergy Immunol. ;2[1]:52-53. Abstract Review No. AR1.

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The introduction of biologicals for the treatment of inflammatory bowel disease (IBD) is an important therapeutic tool, but their usefulness is limited in patients with hypersensitivity reaction. Rapid desensitisation (RD) is used to overcome this problem.1 The aim of our study was to evaluate RD safety and efficiency for the management of hypersensitivity reaction to infliximab (INX) and adalimumab (ADL) in IBD patients.

The study population consisted of 50 IBD patients, with a mean age of 40 years (17–64 years). The group consisted of 40 women (80%). We examined patients from September 2012– December 2016 in a prospective manner. Of the 50 individuals studied, 45 (90%) had Crohn’s disease, 4 (8%) had ulcerative colitis, and 1 (2%) had IBD in undifferentiated form. A total of 19 (38%) patients had adverse reactions to INX, 16 (32%) to ADL, and 15 (30%) to both INX and ADL.

The stratification of patients according to Pichler’s classification2 of adverse reactions to biologicals revealed that 7 (14%) of the patients had type alpha, 27 (54%) type beta, 14 (28%) type gamma, no patients had type delta, and 2 (4%) had type epsilon. For allergology work-up, skin prick tests with undiluted and intradermal tests with 1/10 and 1/100 dilution were carried out with INX and ADL.3 Both tests were evaluated at 20 minutes for immediate reactions and at 24, 48, and 72 hours for late reactions. Skin tests were positive in 5 (10%) patients. A basophile activation test (BAT) was carried out according to known methodology in used concentration. For INX: 25, 10, 5, and 2.5 µg/mL and for ADL: 125, 50, 25, and 12.5 µg/mL. BAT was positive in 7 (17%) patients. Anti-INX and anti-ADL antibodies were not detected. RD was indicated when skin test and/or BAT were positive and/or based only on a clinical course of adverse reaction.

RD was performed in 20 (40%) patients, with INX in 8 (40%) and with ADL in 12 (60%) of those patients. For RD, we used the previously published protocols.1,4 Montelukast, anti-H1 and H2 blockers, and systemic steroids were used for the premedication. All procedures (skin and blood tests, desensitisation) were carried out with the informed consent of the patients. Successful RD was performed in 16 (80%) patients. In four (20%) patients RD had to be stopped early due to adverse reactions (dyspnoea and exanthema in two patients, decrease of C3 and C4 complement proteins in one, and flu-like syndrome in one).

In conclusion, RD is an effective method in people with an allergic reaction to biologicals because it allows the return of these drugs for IBD treatment.

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