A patient receiving an infusion of cetuximab as part of a chemotherapeutic regimen may develop an acute hypersensitivity reaction, which may be severe.
Cetuximab is a chimeric mouse-human IgG1 monoclonal antibody against epidermal growth factor receptor.
Patients who develop an infusion reaction when starting therapy have anti-cetuximab IgE antibodies which can be detected prior to starting therapy. These antibodies target the oligosaccharide galactose-alpha-1,3-galactose (anti-alpha-gal) which is present in the Fab chain. These specificity is assoicated with the meat hypersensitivity syndrome.
Other risk factors for an infusion reaction:
(1) male gender
(2) current smoker
(3) previous allergic reaction to cetuximab
This immune response should be distinguished from anti-mouse IgG antibodies that may form after repeated use.
A patient with IgE antibodies can undergo desensitization therapy.
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