Hypersensitivity reactions to biologics in children

ABSTRACT

Introduction

Hypersensitivity reactions (HSRs) have been observed with the use of biologics in children. The management of HSRs in children is mainly based on experiences from the adult population. Recently, data from different centers experienced in managing these reactions, including desensitization in children, have been published, allowing clinicians to have an appropriate global overview and compare results.

Areas covered

This review highlights the published data on hypersensitivity reactions to biologics in children and drug desensitization protocols adapted to the pediatric population.

Expert opinion

With regard to HSRs to biologics in children, few data are available. Compared with the adult population, there is a lack of knowledge in the endophenotypes, management and the standardization of protocols including premedication regimens in children. An international consensus is needed to provide clinicians with new insight on how to apply personalized management and to perform tailored desensitization protocols in pediatric populations. Various specialists including allergists, pediatricians, oncologists, hematologists, rheumatologists, and pharmacists, should build a multidisciplinary management team to keep pediatric patients on their best treatment options in the safest manner.

KEYWORDS:

• Biologics
• drug allergy
• biological drugs
• pediatrics
• IgE-mediated
• non-IgE-mediated reactions
• anti-drug antibodies
• complement activation
• drug desensitization
• precision medicine

Article highlights

• Currently, management of HSRs to biologics in children is based on evidence published in adult populations.

• Recently, some centers with expertise in managing these reactions in children have provided data about the successful outcomes of desensitization to biologics in children. However, there is still a lack of evidence to have a solid literature in this population.

• An international consensus on the management of HSRs and the standardization of drug desensitization protocols for children is still needed.

• Multidisciplinary teams including allergists, pediatricians, and pharmacists are essential for a better management approach of pediatric patients allergic to biologics, in order to keep them on their best treatment option.

Declaration of interest

R Madrigal-Burgaleta has collaborated in grants from Consejeria de Salud, Junta de Andalucia (Malaga, Spain), and has received honoraria or consultation fees from the Catalan Institute of Oncology, Barcelona, Spain, Allergy Therapeutics, Drug Hypersensitivity International Meeting (Barcelona, Spain), and the Spanish Society for Allergy and Clinical Immunology (SEAIC). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.