Infusion Reactions to Infliximab in Pediatric Patients with Inflammatory Bowel Disease

Infliximab (IFX) is a recombinant DNA-derived chimeric IgG monoclonal antibody protein that inhibits tumor necrosis factor alpha (TNF-α). IFX, like other agents derived from foreign proteins, can cause infusion reactions both during and after the infusion. The incidence of infusion reactions ranges...

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Main Authors: Rajmohan Dharmaraj, Tess Pei Lemon, Rasha Elmaoued, Ricardo Orlando Castillo, Razan Alkhouri
Format: Article
Language:English
Published: MDPI AG 2024-11-01
Series:Children
Subjects:
Online Access:https://www.mdpi.com/2227-9067/11/11/1366
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author Rajmohan Dharmaraj
Tess Pei Lemon
Rasha Elmaoued
Ricardo Orlando Castillo
Razan Alkhouri
author_facet Rajmohan Dharmaraj
Tess Pei Lemon
Rasha Elmaoued
Ricardo Orlando Castillo
Razan Alkhouri
author_sort Rajmohan Dharmaraj
collection DOAJ
description Infliximab (IFX) is a recombinant DNA-derived chimeric IgG monoclonal antibody protein that inhibits tumor necrosis factor alpha (TNF-α). IFX, like other agents derived from foreign proteins, can cause infusion reactions both during and after the infusion. The incidence of infusion reactions ranges between 0% and 15% in pediatric patients. The potential underlying mechanisms for these reactions may include anaphylaxis and anaphylactoid reactions, cytokine release syndrome, serum sickness-like reactions, and the development of antibodies against IFX. Several precautions can help reduce the risk of a new infusion reaction, such as a gradual increase in the infusion rate, scheduled infusions, and administering premedication or immunomodulators alongside IFX. Acute mild to moderate reactions often resolve spontaneously after a temporary cessation of the infusion or reduction in the infusion rate. Strategies like graded dose challenges and premedication can be utilized to prevent recurrence. In cases of severe reactions, desensitization or switching to an alternative biologic may be considered. This article aims to review the most recent guidelines for managing IFX-related infusion reactions in pediatric patients with inflammatory bowel disease (IBD), relying on the best available evidence.
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spelling doaj-art-ea41ef5345ab49f394deb042e20a571c2025-08-20T02:08:09ZengMDPI AGChildren2227-90672024-11-011111136610.3390/children11111366Infusion Reactions to Infliximab in Pediatric Patients with Inflammatory Bowel DiseaseRajmohan Dharmaraj0Tess Pei Lemon1Rasha Elmaoued2Ricardo Orlando Castillo3Razan Alkhouri4Division of Gastroenterology, Department of Pediatrics, University of New Mexico, Albuquerque, NM 87131, USADivision of Gastroenterology, Department of Pediatrics, University of New Mexico, Albuquerque, NM 87131, USADivision of Gastroenterology, Department of Pediatrics, University of New Mexico, Albuquerque, NM 87131, USADivision of Gastroenterology, Department of Pediatrics, University of New Mexico, Albuquerque, NM 87131, USADivision of Gastroenterology, Department of Pediatrics, University of New Mexico, Albuquerque, NM 87131, USAInfliximab (IFX) is a recombinant DNA-derived chimeric IgG monoclonal antibody protein that inhibits tumor necrosis factor alpha (TNF-α). IFX, like other agents derived from foreign proteins, can cause infusion reactions both during and after the infusion. The incidence of infusion reactions ranges between 0% and 15% in pediatric patients. The potential underlying mechanisms for these reactions may include anaphylaxis and anaphylactoid reactions, cytokine release syndrome, serum sickness-like reactions, and the development of antibodies against IFX. Several precautions can help reduce the risk of a new infusion reaction, such as a gradual increase in the infusion rate, scheduled infusions, and administering premedication or immunomodulators alongside IFX. Acute mild to moderate reactions often resolve spontaneously after a temporary cessation of the infusion or reduction in the infusion rate. Strategies like graded dose challenges and premedication can be utilized to prevent recurrence. In cases of severe reactions, desensitization or switching to an alternative biologic may be considered. This article aims to review the most recent guidelines for managing IFX-related infusion reactions in pediatric patients with inflammatory bowel disease (IBD), relying on the best available evidence.https://www.mdpi.com/2227-9067/11/11/1366infiximabinfusion reactionchildrenpreventionmanagement
spellingShingle Rajmohan Dharmaraj
Tess Pei Lemon
Rasha Elmaoued
Ricardo Orlando Castillo
Razan Alkhouri
Infusion Reactions to Infliximab in Pediatric Patients with Inflammatory Bowel Disease
Children
infiximab
infusion reaction
children
prevention
management
title Infusion Reactions to Infliximab in Pediatric Patients with Inflammatory Bowel Disease
title_full Infusion Reactions to Infliximab in Pediatric Patients with Inflammatory Bowel Disease
title_fullStr Infusion Reactions to Infliximab in Pediatric Patients with Inflammatory Bowel Disease
title_full_unstemmed Infusion Reactions to Infliximab in Pediatric Patients with Inflammatory Bowel Disease
title_short Infusion Reactions to Infliximab in Pediatric Patients with Inflammatory Bowel Disease
title_sort infusion reactions to infliximab in pediatric patients with inflammatory bowel disease
topic infiximab
infusion reaction
children
prevention
management
url https://www.mdpi.com/2227-9067/11/11/1366
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AT ricardoorlandocastillo infusionreactionstoinfliximabinpediatricpatientswithinflammatoryboweldisease
AT razanalkhouri infusionreactionstoinfliximabinpediatricpatientswithinflammatoryboweldisease