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Description
Cetuximab, the IgG1 subclass chimeric mouse-human monoclonal antibody biologic that targets the epidermal growth factor receptor (EGFR), is used worldwide for the treatment of EGFR-positive unresectable progressive/recurrent colorectal cancer and head and neck cancer. Research has shown that the principal cause of cetuximab-induced anaphylaxis is anti-oligosaccharide IgE antibodies specific for galactose-α-1,3-galactose (α-Gal) oligosaccharide present on the mouse-derived Fab portion of the cetuximab heavy chain. Furthermore, it has been revealed that patients who are allergic to cetuximab also develop an allergic reaction to mammalian meat containing the same α-Gal oligosaccharide owing to cross-reactivity, and the presumed cause of sensitization is tick bites: Amblyomma in the United States, Ixodes in Australia and Europe, and Haemaphysalis in Japan. The α-Gal-specific IgE test (bovine thyroglobulin-conjugated ImmunoCAP) or CD63-expression-based basophil activation test may be useful to identify patients with IgE to α-Gal in order to predict risk for cetuximab-induced anaphylactic shock. Investigations of cetuximab-related anaphylaxis have revealed three novel findings that improve our understanding of immediate-type allergy: 1) oligosaccharide can serve as the main IgE epitope of anaphylaxis; 2) because of the oligosaccharide epitope, a wide range of cross-reactivity with mammalian meats containing α-Gal similar to cetuximab occurs; and 3) tick bites are a crucial factor of sensitization to the oligosaccharide. Nonetheless, taking a medical history of tick bites and beef allergy may be insufficient to prevent cetuximab-induced anaphylaxis, and therefore blood testing with an α-Gal-specific IgE test, with high sensitivity and specificity, is necessary to detect sensitization to α-Gal.
Subject
Anaphylaxis
Cetuximab
Galactose-α-1
3-galactose
Red meat allergy
Tick bites
Journal Title
Allergology International
Volume
68
Issue
3
Start Page
296
End Page
300
ISSN
1323-8930
ISSN(Online)
1440-1592
Published Date
2019/07/12
DOI
Publisher
一般社団法人日本アレルギー学会
Publisher Transcription
イッパン シャダン ホウジン ニホン アレルギー ガッカイ
Publisher Aalternative
Japanese Society of Allergology
NII Type
Journal Article
Format
PDF
Relation
Rights
表示 - 非営利 - 改変禁止 4.0 国際 (CC BY-NC-ND 4.0) https://creativecommons.org/licenses/by-nc-nd/4.0/deed.ja
Text Version
出版社版
Gyoseki ID
e38190
OAI-PMH Set
Faculty of Medicine
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