Because of their selectivity, biologicals are crucial therapeutic agents in oncological, immunological, and inflammatory diseases and their use in clinical practice is broadening. Biologicals are among the most common drugs that can cause hypersensitivity reactions (HSRs), and this is primarily attributed to an explosion in new treatment options that has developed through personalized and precision medicine. Patients can develop HSRs to these agents during the first lifetime exposure or after repeated exposure. Despite its relatively high prevalence, the underlying mechanisms and optimal management of HSRs to biologicals remain incompletely explained. In this position paper, the authors provided evidence-based recommendations for the diagnosis and management of HSRs to biologicals. Additionally, the document defines unmet needs, which should be topics of future studies.
Chemotherapeutic drugs have been widely used in the treatment of cancer disease for about 70 years and, even with the development of new therapies, they are still prescribed by oncologists, alone or in combination with other antineoplastic agents. All chemotherapies are able to provoke hypersensitivity reactions, even with different incidences, depending on the different class of these drugs, and these reactions are the third leading cause of fatal drug-induced anaphylaxis in the United States. In Europe deaths related to chemotherapy have also been reported. In particular, most reactions are provoked by platinum compounds, taxanes, epipodophyllotoxins and asparaginase. However, currently there are different points of view about the best procedures for the diagnosis, treatment and prevention of these reactions. Thus, the European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology organized a task force to provide data and recommendations regarding the allergological work up in this field of drug hypersensitivity reactions. The aims of this position paper were to provide consensus on the investigation of HSRs to chemotherapeutic drugs and to give practical suggestions for clinicians that treat these patients, such as oncologists, allergologists and internists. Key sections cover: risk factors, pathogenesis, symptoms, role of skin tests, in vitro tests, indications and contraindications of drug provocation tests and desensitization of neoplastic patients with allergic reactions to chemotherapeutic drugs. Statements, recommendations and unmet needs were discussed and proposed at the end of each section.
Elevated serum IgE levels are associated with allergic disorders, parasitosis and specific immunologic abnormalities. In addition, epidemiological and mechanistic evidence indicates an association between IgE-mediated immune surveillance and protection from tumour growth. Intriguingly, recent studies reveal a correlation between IgE deficiency and increased malignancy risk. This is the first review focusing on IgE levels and links to pathological conditions, with special focus on the potential clinical significance of ultra-low serum IgE levels and risk of malignancy. In this Position Paper we discuss: a) the utility of measuring total IgE levels in the management of allergies, parasitosis, and immunodeficiencies, b) factors that may influence serum IgE levels, c) IgE as a marker of different disorders, and d) the relationship between ultra-low IgE levels and malignancy susceptibility. While elevated serum IgE is generally associated with allergic/atopic conditions, very low or absent IgE may hamper anti-tumour surveillance, indicating the importance of a balanced IgE-mediated immune function. Ultra-low IgE may prove to be an unexpected biomarker for cancer risk. Nevertheless, given the early stage of investigations conducted mostly in cohort of patients with diseases that influence IgE levels, in-depth mechanistic studies and stratification of malignancy risk based on associated demographic, immunological and clinical co-factors are warranted.