Immunology and allergy clinics of North America
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Immunol Allergy Clin North Am · Nov 2017
ReviewMonoclonal Antibodies Hypersensitivity: Prevalence and Management.
The use of monoclonal antibodies (mAbs) has become broader because of their recognized effectiveness in the treatment of autoimmune, neoplastic, and inflammatory diseases. Consequently, hypersensitivity reactions (HSR) secondary to mAbs are being reported more often, and each mAb-related HSR presents specific features. This article discusses the main biological agents and associated HSR, the clinical presentation of such reactions, and the role of tryptase and skin testing in the diagnosis. Rapid drug desensitization procedures to mAbs enable selected allergic patients to receive full therapeutic doses in a safe manner and are also discussed.
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Ten percent of patients report penicillin allergy, but more than 90% of these individuals can tolerate penicillins. Skin testing remains the optimal method for evaluation of possible IgE-mediated penicillin allergy and is recommended by professional societies, as the harms for alternative antibiotics include antimicrobial resistance, prolonged hospitalizations, readmissions, and increased costs. ⋯ There is minimal allergic cross-reactivity between penicillins and cephalosporins. IgE-mediated allergy to cephalosporins is usually side-chain specific and may warrant graded challenge with cephalosporins containing dissimilar R1 or R2 group side chains.