PDF(Pubmed)
Abstract：
Upon first exposure to cetuximab, hypersensitivity reactions can occur. We aimed to assess the utility of the basophil activation test (BAT) to alpha-gal and cetuximab for predicting severe reactions. We prospectively recruited 38 patients and evaluated sIgE to alpha-gal in all patients before the first application of cetuximab. In all alpha-gal-sensitized patients, we evaluated skin tests to meat extracts, gelatine, and cetuximab and performed BAT with alpha-gal and cetuximab. In 24% (9/38) of patients, sIgE to alpha-gal was >0.10 kUA/L, and 8/9 reacted to the cetuximab. Basophil activation tests with alpha-gal were positive in all sensitized patients and were higher in those with severe reactions (18.3% in grade 4 [n = 4] vs. 1.8% in grade 2 [n = 3] or no reaction [n = 1] at 3.3 ng/mL of alpha-gal; p = 0.03). All patients with severe grade 4 reactions had a positive CD63 BAT response to cetuximab compared to patients with moderate or no reaction, who all had negative BAT (57.7% vs. 0.9% at 500 µg/mL, 63.2% vs. 4.1% at 100 µg/mL, 58.2% vs. 2.7% at 10 µg/mL, and 32.1% vs. 3.3% at 1 µg/mL of cetuximab, respectively; p ≤ 0.001). In summary, before initiating cetuximab treatment, sIgE to alpha-gal should be assessed in all patients. To predict the severity of the reaction and to assess the risk of cetuximab-induced anaphylaxis, we should perform BATs with alpha-gal or more discriminative BATs with cetuximab.
摘要：
第一次接触西妥昔单抗后,可能发生超敏反应。我们旨在评估嗜碱性粒细胞活化试验（BAT）对α-gal和西妥昔单抗预测严重反应的实用性。我们前瞻性招募了38例患者，并在首次应用西妥昔单抗之前评估了所有患者的sIgE对α-gal的影响。在所有α-gal致敏患者中，我们评估了肉类提取物的皮肤测试，明胶,和西妥昔单抗，并用α-gal和西妥昔单抗进行BAT。在24%（9/38）的患者中，sIgE对α-gal>0.10kUA/L，和8/9与西妥昔单抗反应。在所有致敏患者中，α-gal的嗜碱性粒细胞激活试验均为阳性，在严重反应的患者中更高（4级为18.3％[n=4]与在2级中1.8％[n=3]或在3.3ng/mL的α-gal下无反应[n=1]；p=0.03）。与中度或无反应的患者相比，所有严重4级反应的患者对西妥昔单抗的CD63BAT反应均为阳性，谁都有负面的BAT（57.7%vs.在500µg/mL时为0.9％，63.2%vs.在100µg/mL时为4.1％，58.2%vs.在10µg/mL时为2.7％，和32.1%vs.在1µg/mL西妥昔单抗时为3.3％，分别为；p≤0.001)。总之,在开始西妥昔单抗治疗之前，应在所有患者中评估sIgE至α-gal。为了预测反应的严重程度并评估西妥昔单抗引起的过敏反应的风险，我们应该使用α-gal进行BAT或使用西妥昔单抗进行更有区别的BAT.
