Infusion reactions induced by cetuximab

Abstract

Cetuximab, a human–mouse chimeric IgG1 monoclonal antibody used against the epidermal growth factor receptor, is approved for the treatment of squamous cell carcinoma of the head and neck. Currently, cases of hypersensitivity to cetuximab are attributed to the production of an IgE antibody specific for galactose-alpha-1,3-galactose (α-Gal) positioned on the Fab portion of the cetuximab heavy chain. Because such IgE antibodies bind to various mammalian proteins, red meat allergy is also related to α-Gal. In addition, tick bites also induce the production of this IgE antibody against α-Gal. Therefore, we retrospectively investigated 17 patients diagnosed with head and neck cancer for the incidence of infusion reactions, following cetuximab chemotherapy from January to December 2013 at the Department of Otolaryngology-Head and Neck Surgery, Ehime University Hospital. We conducted serological analysis for specific IgE reactions to beef, pork, chicken, α-Gal and interviewed the patients to see whether or not they had tick bites. Infusion reactions were observed in 4 patients (23.5%) and IgE antibodies specific for pork, chicken, or α-Gal were detected in 3 of these 4 patients. These data suggest that the infusion reactions resulted from allergic reactions induced by cetuximab-containing α-Gal.