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A case of anaphylaxis to alemtuzumab

  • Charles J. S. NyeEmail author
  • Annette Wagner
  • Onajite Kousin-Ezewu
  • Joanne L. Jones
  • Alasdair J. Coles
Letter to the Editors

Dear Sirs,

Alemtuzumab (Lemtrada) is a humanised monoclonal antibody targeting CD52 found on lymphocytes and monocytes, and is a highly effective treatment of relapsing–remitting multiple sclerosis [1, 2, 3]. At baseline five consecutive daily doses of 12 mg IV are given, with no further treatment until 12 months later, when patients receive three consecutive doses of 12 mg IV.

Over 90% of patients receiving alemtuzumab experience infusion-associated reactions. Work in the 1990s showed that these could be reduced or ameliorated by pretreatment with corticosteroids [4] and that the underlying mechanism was a programmed release of cytokines from natural killer cells, triggered by Fc cross-linking [5]. When severe, these reactions may include a rash, fever, hypotension and bronchospasm and so mimic anaphylaxis; they are, therefore, termed “anaphylactoid”. This phenomenon has led to confusion in the current literature as to whether patients may develop genuine anaphylaxis to alemtuzumab.

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Notes

Acknowledgements

The patient was treated on the NIHR Cambridge Clinical Research Facility.

Funding

The Medical Research Council funded the CAMTHY trial.

Compliance with ethical standards

Conflicts of interest

Both AC and JJ have received honoraria and travel costs for attending scientific advisory boards.

Ethical standards

All human studies have been approved by the appropriate ethics committee and have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The patient in this case study gave her informed consent for the report to be written.

References

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    Cohen JA, Coles AJ, Arnold DL, Confavreux C, Fox EJ, Hartung H-P et al (2012) Alemtuzumab versus interferon beta 1a as first-line treatment for patients with relapsing–remitting multiple sclerosis: a randomised controlled phase 3 trial. Lancet 380(9856):1819–1828CrossRefGoogle Scholar
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    Caon C, Namey M, Meyer C, Mayer L, Oyuela P, Margolin DH et al (2015) Prevention and management of infusion-associated reactions in the comparison of alemtuzumab and rebif® efficacy in multiple sclerosis (CARE-MS) program. Int J MS Care 17(4):191–198CrossRefPubMedCentralGoogle Scholar
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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.University of CambridgeCambridgeUK
  2. 2.Department of Allergy and ImmunologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
  3. 3.Department of Clinical NeurosciencesCambridge University Hospitals NHS Foundation TrustCambridgeUK

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