Abstract
PurposeTo describe a series of non-immediate drug hypersensitivity reactions after intravitreal anti-vascular endothelial growth factors (anti-VEGFs).Patients and methodsRetrospective report of 6 patients with cutaneous non-immediate drug hypersensitivity reactions following intravitreal anti-VEGF injections, 4 after ranibizumab, 1 after bevacizumab and 1 after aflibercept.ResultsClinical manifestations ranged from mild maculopapular rash, purpura to severe generalized erythroderma, with or without systemic involvement such as microscopic hematuria and proteinuria or fever. In two out of the six patients, reintroduction of either the same or an alternative anti-VEGF drug did induce a recurrence of the drug hypersensitivity reaction, while 4 patients showed no recurrence.ConclusionCutaneous non-immediate drug hypersensitivity reactions secondary to intravitreal anti-VEGF may occur. Continuation of the same drug or switch to another anti-VEGF may either induce recurrence or be well supported by the patient. The decision of drug discontinuation should be guided by the severity of the disease.
Highlights
From 2006, intravitreal anti-vascular endothelial growth factors have become the standard treatment in ophthalmology, which has been shown to be effective in a growing number of retinal diseases.Anti-VEGF molecules are directed against the action of VEGF-A, a mediator protein promoting intraocular angiogenesis and vascular permeability
Four anti-VEGFs are currently used for intravitreal treatment: bevacizumab, ranibizumab, aflibercept and brolucizumab, the four of them differing in their molecular structure (Fig. 1)
A new anti-VEGF molecule has been introduced to the market: brolucizumab is a single-chain antibody fragment, the smallest functional subunit of an antibody, which was developed by grafting two complementarity-determining regions of the anti-VEGF molecule to a human scFv scaffold
Summary
From 2006, intravitreal anti-vascular endothelial growth factors (anti-VEGFs) have become the standard treatment in ophthalmology, which has been shown to be effective in a growing number of retinal diseases.Anti-VEGF molecules are directed against the action of VEGF-A, a mediator protein promoting intraocular angiogenesis and vascular permeability. A new anti-VEGF molecule has been introduced to the market: brolucizumab is a single-chain antibody fragment (scFv), the smallest functional subunit of an antibody, which was developed by grafting two complementarity-determining regions of the anti-VEGF molecule to a human scFv scaffold. It has a smaller molecular weight of 26 kDa and binds all isoforms of VEGF-A [6]
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