Biologics and anaphylaxis

Curr Opin Allergy Clin Immunol. 2019 Oct;19(5):439-446. doi: 10.1097/ACI.0000000000000550.


Purpose of review: The use of biologicals as therapeutic agents in oncology and other inflammatory diseases has dramatically increased during the last years. Due to their biological nature and inherent immunological activity, they are able to induce important adverse events, such as cytokine release reactions (rapid release of proinflammatory cytokines), serum sickness disease, and immediate or delayed hypersensitivity reactions, including anaphylaxis. The aim of the current article is to review the state of the art of anaphylaxis because of biological agents.

Recent findings: Different phenotypes, and potential underlying endotypes, have been described in anaphylactic reactions to biologicals. There seems to be a spectrum from type 1 reactions (IgE or non-IgE-mediated) to cytokine release reactions, with some reactions falling in between both. Management should be directed according to such phenotypes.

Summary: There is ongoing research to further define immediate adverse reactions to biologicals and to find relevant biomarkers to aid in their diagnosis. Such information will serve in defining their immediate and long term management.

Publication types

  • Review

MeSH terms

  • Anaphylaxis / drug therapy*
  • Animals
  • Antibodies, Monoclonal / therapeutic use*
  • Biological Products / therapeutic use*
  • Biological Therapy / methods*
  • Cytokines / metabolism
  • Drug-Related Side Effects and Adverse Reactions
  • Humans
  • Hypersensitivity / drug therapy*
  • Immunoglobulin E / metabolism


  • Antibodies, Monoclonal
  • Biological Products
  • Cytokines
  • Immunoglobulin E