{
  "abstract": "Infliximab (IFX) is an anti-TNF monoclonal, IgG2a antibody (TNF-alpha) used in the treatment of paediatric inflammatory bowel disease (IBD). There is a 5-23% risk of Drug Hypersensitivity Reactions (DHR) to IFX infusion in IBD patients. 1 Potential DHR include anaphylaxis, cytokine release syndrome, and serum sickness through host antibody to infliximab responses.2–4 For those with severe reactions – options include avoidance, change of drug or desensitisation.5 6 Research has shown that premedication is not effective in reducing rate of infusion reactions due to IFX.7A retrospective cohort review identified paediatric IBD patients treated with infliximab over an 8 year period. Each case had a DHR during an infusion. The total paediatric IBD cohort of 352 patients over that time included 160 patients treated with IFX. 13 (8%) had an acute drug reactions (see table 1). 7 patients reacted during their induction regime; 3 patients had >10 previous infusions. Standard induction regime of 0, 2 and 6 weeks was used in 12 patients, 1 patient was accelerated 0, 1 and 4 weeks. Doses (in mg/kg) ranged from 5 (3), 10 (7) to 20 (3) and frequency (in weeks) from 4 (1), 6 (2) to 8 (3). 10 patients were on co-existing IBD medication including azathioprine (8), allopurinol (2), 5-ASA (2) and methotrexate (1). Anti-infliximab levels were raised in 2 patients at >200 and 147.4ng/ml. Infliximab levels were low (<5mcg/ml) in 5 patients. Intravenous (IV) hydrocortisone was given as a pre-medication in 8 patients. Reaction symptoms included rash (10), itchiness (3), facial swelling (2), nausea/vomiting (2) and respiratory compromise (7) including documented oxygen desaturation (3). Acute treatment included antihistamine (11), Intramuscular (IM) adrenaline (5) and IV hydrocortisone (1). 5 patients required overnight admission for monitoring. Mast Cell Tryptase (MCT) levels were checked in 8 patients; only 1 was mildly raised (19ug/L at baseline, 23ug/L at 4 hours). 5 patients were referred to allergy clinic for follow-up. All 13 patients were switched to adalimumab for ongoing management of their IBD.We have identified significant drug reactions in 13 (8%) of our paediatric IBD patients treated with IFX. Half of these reactions involved respiratory compromise although only a third received IM adrenaline. It is yet to be analysed which type of DHR is involved- a Type 1-DHR or other Type 2-4 DHR. This may reflect involvement of trained immunity pathways alongside conventional hypersensitivity mechanisms.8 More research is needed on this matter and on appropriate risk assessments and management algorithms for this patient group.References Lichtenstein L, Ron Y, Kivity S. Infliximab-related infusion reactions: systematic review. J Crohns Colitis. 2015 Sep;9(9):806–15.Dharmaraj R, Lemon TP, Elmaoued R. Infusion reactions to infliximab in pediatric patients with inflammatory bowel disease. Children 2024;11(11):1366.Jutel M, Agache I, Zemelka-Wiacek M. Nomenclature of allergic diseases and hypersensitivity reactions: adapted to modern needs: an EAACI position paper. Allergy. 2023;78:2851–2874.National Institute for Health and Care Excellence (NICE). Anaphylaxis: assessment and referral after emergency treatment. CG134. Overview | Anaphylaxis: assessment and referral after emergency treatment | Guidance | NICENational Institute for Health and Care Excellence (NICE). Drug allergy: diagnosis and management. CG183. Overview | Drug allergy: diagnosis and management | Guidance | NICEMadrigal-Burgaleta R, Guzman-Melendez MA, Alvarez-Cuesta E. Drug allergy desensitization is not a unique recipe. Curr Opin Allergy Clin Immunol. 2022 Jun 1;22(3):167–174.Cullen M, Green Z, Morris K. OC4 Discontinuation of premedication for infliximab infusions is well-tolerated, without adverse events, and cost-saving in paediatric inflammatory bowel disease. Frontline Gastroenterology 2025;16:A3.Martín-Cruz L, Palomares O. Allergen-specific immunotherapy and trained immunity. Allergy 2025;80:677–689.Abstract OC85 Table 1Patient characteristics (n=13)Characteristicn (%)Gender Male5 (38) Female8 (62)Diagnosis Crohn’s disease7 (54) Ulcerative Colitis6 (46)Age (years) Mean11 Range 5 to 16History of atopy Personal history8 (62) Asthma5 (38) Eczema4 (31) Hayfever7 (54) IgE mediated food allergy1 (8) Family history7 (54) Drug allergy3 (23)",
  "authors": [
    {
      "affiliations": [
        "Great North Children’s Hospital, Newcastle Upon Tyne"
      ],
      "name": "Poppy Richardson"
    },
    {
      "affiliations": [
        "Great North Children’s Hospital, Newcastle Upon Tyne"
      ],
      "name": "Peter Busby"
    },
    {
      "affiliations": [
        "Great North Children’s Hospital, Newcastle Upon Tyne"
      ],
      "name": "Rachel Allcoat"
    },
    {
      "affiliations": [
        "Great North Children’s Hospital, Newcastle Upon Tyne"
      ],
      "name": "Louise Michaelis"
    },
    {
      "affiliations": [
        "Great North Children’s Hospital, Newcastle Upon Tyne"
      ],
      "name": "David Campbell"
    }
  ],
  "title": "OC85 Acute drug hypersensitivity reactions to infliximab in paediatric IBD patients: a single centre experience",
  "uid": "c052a437-01f5-5e0c-abaa-2b26ad1977a8"
}