DESENSITIZATION TO PERTUZUMAB/TRASTUZUMAB/HYALURONIDASE-ZZXF IN A PATIENT WITH HYMENOPTERA ANAPHYLAXIS

• Published in: Annals of allergy, asthma, & immunology Vol. 133; no. 6; pp. S120 - S121
• Main Authors: Saldana-Fraire, V., De León, L. Romo, Estrada-Mendizabal, R., Gonzalez-Estrada, A., Paredes, A. Canel
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.11.2024
• ISSN: 1081-1206
• DOI: 10.1016/j.anai.2024.08.513

Trastuzumab and pertuzumab, monoclonal antibodies (mAbs) against epidermal growth factor receptor 2 (HER2), improve survival in HER-2-positive breast cancer. Hyaluronidase-based mAb formulations may be more pragmatic than intravenous forms. Hyaluronidase is also present in the venom of hymenoptera. A 44-year-old female patient with a history of anaphylaxis due to bee stings and metastatic HER2/neu (+) breast cancer was enrolled in a pertuzumab/trastuzumab/hyaluronidase-zzxf clinical trial. Seventeen minutes into the first subcutaneous administration, she experienced epigastric pain, nausea, urgency to defecate, throat tightness, dyspnea, cough, oxygen desaturation of 80%, and a sense of impending doom. Tryptase was not obtained due to financial constraints. The infusion was held, and epinephrine was administered, resolving the symptoms immediately. Skin tests for trastuzumab and pertuzumab mixed with hyaluronidase, as well as hymenoptera venom (bee, wasp, and ant), were performed three weeks after the initial episode, yielding negative results. A single-bag 13-step subcutaneous desensitization protocol was performed (Figure 1). Breakthrough symptoms included mild chest tightness and epigastric pain, which resolved without intervention. A second desensitization was conducted without any adverse reactions. The patient was withdrawn from the trial, as her anaphylactic reaction was an exclusion criterion. Although reports of anaphylaxis have emerged during pertuzumab/trastuzumab/hyaluronidase-zzxf clinical trials, information regarding previous hymenoptera venom allergies is not reported, and the information available about cross-reactivity with recombinant hyaluronidases is limited. Clinicians must be aware of safe and effective desensitization protocols for patients with hypersensitivity to pertuzumab/trastuzumab/hyaluronidase-zzxf.