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Natalizumab is a new therapeutic option for relapsing-remitting multiple sclerosis. As with other antibody therapies, hypersensitivity reactions have been observed. In the Natalizumab Safety and Efficacy in Relapsing-Remitting Multiple Sclerosis (AFFIRM) trial, infusion-related hypersensitivity reactions developed in 4% of patients, usually within 2 hours after starting the infusion.
To report a significant, delayed, serum sickness–like, type III systemic allergic reaction to natalizumab.
Case report describing clinical follow-up and the serial measurement of antinatalizumab antibodies.
A 23-year-old man with relapsing-remitting multiple sclerosis developed a fever, arthralgias, urticarial exanthema, and a swollen lower lip during several days after his second infusion of natalizumab.
The patient developed a delayed, serum sickness–like, type III systemic allergic reaction to natalizumab. Five weeks after initiation of this therapy, he tested positive for antinatalizumab antibodies and exhibited persistent antibody titers 8 and 12 weeks later. His symptoms completely resolved with a short course of oral glucocorticosteroids.
Clinicians and patients should be alert not only to immediate but also to significantly delayed substantial allergic reactions to natalizumab.
Krumbholz M, Pellkofer H, Gold R, Hoffmann LA, Hohlfeld R, Kümpfel T. Delayed Allergic Reaction to Natalizumab Associated With Early Formation of Neutralizing Antibodies. Arch Neurol. 2007;64(9):1331–1333. doi:https://doi.org/10.1001/archneur.64.9.1331
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