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Master thesis

IgE anti-infliximab et tests cutanés dans les hypersensibilités immédiates à l’infliximab dans les maladies inflammatoires chroniques de l’intestin

Abstract : Background: Infliximab (IFX) is a chimeric monoclonal antibody directed against tumor necrosis factor-alpha, used for the treatment of inflammatory bowel diseases (IBD). Immediate hypersensitivity reactions (HR) are frequently reported.Objectives: We investigated the potential IgE-mediated mechanism underlying immediate HR to IFX. Secondary objectives were to evaluate the utility of allergological evaluation for the management of IBD patients with a history of acute HR to IFX and, to evaluate the tolerability of IFX retreatment after HR.Methods: This was a prospective single-center study including pediatric and adult IBD patients with previous immediate HR to IFX. Skin tests to IFX, including prick tests and intradermal tests (IDT), and measurement of anti-IFX IgE antibodies were performed at least 4 weeks after HR. In case of negative skin tests and negative IgE antibodies, IFX re- administration was performed with a twice-reduced infusion rate together with premedication. In case of positive tests or recurrence of HR during IFX re-administration, a twelve-step desensitization protocol was proposed.Results: 24 IBD patients were included (Crohn’s disease: n = 20; ulcerative colitis: n = 4). Prick tests to IFX were all negative. IDT was positive in one patient. Anti-IFX IgE antibodies were negative in 21 patients, positive in one patient, and intermediate in two patients. No relationship was observed between positive skin tests and positivity of anti-IFX IgE antibodies. Switch to adalimumab was well tolerated in 10/11 patients. IFX re-administration was well tolerated in 4/11 patients. Desensitization protocol to IFX was successful in 3 out of 4 patients.Discussion: The vast majority of immediate HR to IFX are not IgE-mediated. Allergological evaluation, including skin tests and measurement of anti-IFX IgE antibodies, is of poor clinical utility. Desensitization protocol may allow continuation of IFX therapy in IBD patients with a history of immediate HR
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Master thesis
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https://hal.univ-lorraine.fr/hal-01733011
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  • HAL Id : hal-01733011, version 1

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Estelle Fréling. IgE anti-infliximab et tests cutanés dans les hypersensibilités immédiates à l’infliximab dans les maladies inflammatoires chroniques de l’intestin. Sciences du Vivant [q-bio]. 2014. ⟨hal-01733011⟩

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