<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0871-9721</journal-id>
<journal-title><![CDATA[Revista Portuguesa de Imunoalergologia]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Port Imunoalergologia]]></abbrev-journal-title>
<issn>0871-9721</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Alergologia e Imunologia Clínica]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0871-97212022000200101</article-id>
<article-id pub-id-type="doi">10.32932/rpia.2022.06.081</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Abordagem de doentes com suspeita de hipersensibilidade a anticorpos monoclonais: Experiência de um serviço]]></article-title>
<article-title xml:lang="en"><![CDATA[Management of patients with suspected hypersensitivity to monoclonal antibodies: Experience of a service]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Lopes]]></surname>
<given-names><![CDATA[Joana B]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Malheiro]]></surname>
<given-names><![CDATA[Daniela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sousa]]></surname>
<given-names><![CDATA[Maria J]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gomes]]></surname>
<given-names><![CDATA[Joana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Brosseron]]></surname>
<given-names><![CDATA[Lise]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Barreira]]></surname>
<given-names><![CDATA[Patrícia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Lopes]]></surname>
<given-names><![CDATA[Inês]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cadinha]]></surname>
<given-names><![CDATA[Susana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Hospitalar de Vila Nova de Gaia/ Espinho EPE Serviço de Imunoalergologia ]]></institution>
<addr-line><![CDATA[Vila de Nova de Gaia ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>06</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>06</month>
<year>2022</year>
</pub-date>
<volume>30</volume>
<numero>2</numero>
<fpage>101</fpage>
<lpage>109</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S0871-97212022000200101&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S0871-97212022000200101&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S0871-97212022000200101&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[RESUMO  Fundamentos:  A crescente utilização de anticorpos monoclonais (mAb) está associada a um aumento de reações de hipersensibilidade (RH). A abordagem de doentes com RH a estes fármacos recentes ainda não está perfeitamente estabelecida.  Objetivo: Caracterizar o estudo alergológico de doentes com suspeita de RH a esta classe de fármacos.  Métodos:  Análise retrospetiva de doentes referenciados à consulta de alergia a fármacos com suspeita de RH a mAb (2013-2019). Diagnóstico confirmado por história clínica sugestiva e testes cutâneos/prova de provocação positivos ou reação reprodutível durante dessensibilização, diagnóstico considerado provável se apenas história sugestiva ou excluído se prova de provocação negativa.  Resultados:  Incluídos 18 doentes, 56% sexo feminino, mediana de idades de 62 anos (23;74). Os fármacos suspeitos foram rituximab, cetuximab, nivolumab, trastuzumab e trastuzumab-emtansina, utilizados no tratamento de neoplasias, púrpura trombocitopénica imune, lúpus eritematoso sistémico e fibrose pulmonar idiopática. Todas as RH foram imediatas. Os sintomas incluíram anafilaxia, febre, manifestações cutâneas, taquicardia e hipertensão arterial. As RH ocorreram na primeira administração em 61% dos doentes. Os testes cutâneos foram positivos em 1 doente (1/8) e as provas de provocação foram negativas (12/12). Pela gravidade e condição clínica subjacente foi realizada dessensibilização em 12 doentes, sendo que 3 tiveram uma reação reprodutível durante o procedimento. Foi confirmado diagnóstico em 17% (n=3), considerado provável em 17% (n=3) e excluído em 67% (n=12).  Conclusões:  Apesar de o mecanismo subjacente à RH ser relevante, a gravidade da reação é o grande determinante na definição do estudo alergológico. Na presença de testes cutâneos negativos e/ou reações ligeiras, recomenda-se a realização de provas de provocação, o que permitiu excluir diagnóstico em 67% dos nossos doentes, apresentando-se como de extrema importância no esclarecimento diagnóstico. Na presença de testes cutâneos positivos e/ou reações moderadas/graves a utilização da dessensibilização como primeira abordagem está recomendada.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Background:  The increasing use of monoclonal antibodies (mAb) is associated with an increase in hypersensitivity reactions (HR). The management of patients with HR to mAbs is not well established.  Objective:  Characterize the allergologic study of patients with suspected HR to this class of drugs.  Methods:  Retrospective analysis of patients referred to our drug allergy department with suspected HR to mAb (2013-2019). Diagnosis was considered confirmed by suggestive clinical history and positive skin tests/drug provocation test or reproducible reaction during desensitization, considered probable when suggestive clinical history and excluded when drug provocation test negative.  Results: Eighteen patients were included, 56% female, median age 62 years (23;74). Culprit drugs were rituximab, cetuximab, nivolumab, trastuzumab and trastuzumab-emtansina used to treat cancer, immune thrombocytopenic purpura, systemic lupus erythematosus and idiopathic pulmonary fibrosis. All HR were immediate. Symptoms included anaphylaxis, fever, skin manifestations, tachycardia and hypertension. HR occurred in the 1st administration in 61% of the patients. Skin tests were positive in 1 patient (1/8) and drug provocation tests were all negative (12/12). Due to the severity and underlying clinical condition, desensitization was performed in 12 patients, 3 of which had a reproducible reaction during the procedure. Diagnosis was confirmed in 17% (n=3), considered probable in 17% (n=3) and excluded in 67% (n=12).  Conclusions:  Although the mechanism underlying HR is relevant, the severity of the reaction is the major determinant in the allergology study definition. In the presence of negative skin tests and/or mild reactions, drug provocation test is recommended, having excluded diagnosis in 67% of our patients, presenting as extremely important in clarifying diagnosis. In the presence of positive skin tests and/or moderate/severe reactions, the use of desensitization as first approach is recommended.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Alergia a fármacos]]></kwd>
<kwd lng="pt"><![CDATA[biológicos]]></kwd>
<kwd lng="pt"><![CDATA[hipersensibilidade]]></kwd>
<kwd lng="pt"><![CDATA[diagnóstico]]></kwd>
<kwd lng="en"><![CDATA[Drug allergy]]></kwd>
<kwd lng="en"><![CDATA[biological]]></kwd>
<kwd lng="en"><![CDATA[hypersensibility]]></kwd>
<kwd lng="en"><![CDATA[diagnose]]></kwd>
</kwd-group>
</article-meta>
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