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Drug allergy: new knowledge

Published on September 30, 2024   56 min

Other Talks in the Series: Periodic Reports: Advances in Clinical Interventions and Research Platforms

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0:00
Hello, everybody. I am Dr. Mariana Castells. I am the Drug Hypersensitivity and Desensitization Center Director at the Brigham and Women's Hospital, and Dana-Farber Cancer Institute at Harvard Medical School here in Boston. My role today is to talk to you about "Drug Allergy: New Knowledge".
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Here are my disclosures.
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The objectives of the current talk are to review current understanding of what is known as phenotypes, endotypes, and bio-markers of drug allergy and hypersensitivity, to provide evidence and management options and delabeling for drug allergy and hypersensitivity, and to address new recommendations for first-line therapy which have induced drug hypersensitivity and allergy including desensitization.
0:56
Rituximab is the world's first oncology monoclonal antibody therapy that was started since very early. The sales for rituximab in 2016 included 8.58 billion, indicating that this was and continues to be one of the most popular targeted therapies. This came as a price. A 68-year-old male with follicular lymphoma who's in remission has been exposed to rituximab for the eighth lifetime exposure. He has severe flushing, sweating, chest pain. The infusion is paused. He's treated with steroids, anti-histamines. The infusion is restarted and the symptoms recur and become more severe. The infusion is then discontinued. What happened to the patient with the perfect drug, with the drug that is addressing his lymphoma? What type of reaction is this? This is what we are going to talk about. What phenotype is this ? What is the mechanism of the reaction? What is underlying the reaction? What's the endotype of the reaction? Do we have any bio-markers to make and address the diagnosis, and what is the management and the approach? As you see here also, the rituximab, new generations of ofatumumab, obinutuzumab are similar molecules that have been humanized and they also have different glycosylation patterns. Despite the fact that the new molecules are not hybrid molecules, they do not contain any murine variable region, those molecules are not completely human and they will be able and capable also of inducing reactions.

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