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Vol. 159, No. 3, 2012
Issue release date: October 2012
Section title: Novel Insights from Clinical Practice
Int Arch Allergy Immunol 2012;159:321–326
(DOI:10.1159/000336839)

Drug-Specific Th2 Cells and IgE Antibodies in a Patient with Anaphylaxis to Rituximab

Vultaggio A. · Matucci A. · Nencini F. · Pratesi S. · Petroni G. · Cammelli D. · Alterini R. · Rigacci L. · Romagnani S. · Maggi E.
aImmunoallergology and bClinical Pathology IV Units, Department of Biomedicine, cHematology Unit, Department of Emergency and Critical Care, Azienda Ospedaliero-Universitaria Careggi, and dCenter for Research, Transfer and High Education Denothe, University of Florence, Florence, Italy

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Article / Publication Details

First-Page Preview
Abstract of Novel Insights from Clinical Practice

Received: 10/9/2011 10:09:56 AM
Accepted: 1/25/2012
Published online: 6/22/2012

Number of Print Pages: 6
Number of Figures: 3
Number of Tables: 0

ISSN: 1018-2438 (Print)
eISSN: 1423-0097 (Online)

For additional information: http://www.karger.com/IAA

Abstract

Rituximab (RTX) is currently used in the treatment of lymphoproliferative diseases and of several rheumatologic disorders and is a frequent cause of acute infusion reactions, usually classified as cytokine release syndrome (CRS). Some infusion reactions to RTX raise concern for immediate type I hypersensitivity, even if to date RTX-specific IgE antibodies have not been reported. To improve knowledge of the mechanisms of reactions to RTX, we investigated humoral and cellular immune responses to this drug in a patient suffering from rheumatoid arthritis who displayed two immediate infusion-related reactions. RTX-exposed tolerant patients and healthy untreated subjects were used as controls. Non-isotype-specific and IgE anti-RTX antibodies were positive in the serum samples collected from the reactive patient but not in those from the control groups. Only the reactive patient also displayed skin testing positivity with RTX. More importantly, RTX-stimulated peripheral blood mononuclear cells from the reactive patient, but not from the controls, displayed a dose-dependent proliferative response associated with a Th2 cytokine production profile. Our results show the presence of RTX-specific Th2-type cells and IgE antibodies, thus suggesting that type I hypersensitivity may be an additional mechanism to CRS in the development of RTX reactions.


Article / Publication Details

First-Page Preview
Abstract of Novel Insights from Clinical Practice

Received: 10/9/2011 10:09:56 AM
Accepted: 1/25/2012
Published online: 6/22/2012

Number of Print Pages: 6
Number of Figures: 3
Number of Tables: 0

ISSN: 1018-2438 (Print)
eISSN: 1423-0097 (Online)

For additional information: http://www.karger.com/IAA


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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