Anaphylaxis Induced by Biologics

Purpose of review: Biologic agents are increasingly utilized in the medical management of many conditions. Their safety has become an important topic as a myriad of reactions can occur due to the immune-modulating properties of these agents. Of these, anaphylaxis remains a substantial concern, but its incidence and pathophysiology have not been comprehensively reviewed. Recent findings: Over the past two decades, a multitude of case reports and series have been published describing anaphylactic reactions to biologic agents, although the true incidence and prevalence remains unknown for the vast majority of them. Based on cytokine and mediator profiles, three mechanisms have been proposed: IgE-mediated, non-IgE-mediated, and cytokine release. Summary: The clinical presentation of anaphylaxis is highly variable between biologic agents. The degree of humanization, excipient involvement, and development process of each biologic agent all likely play an important role in determining its level of allergenicity. As biologic agents become even more commonplace in healthcare, more thorough evaluations of the incidence of anaphylaxis induced by BAs as well as the underlying mechanisms may provide clinically useful data when determining the most appropriate management option.