At a Glance

Monoclonal antibodies have a unique potential for a non- allergic infusion reaction caused by cytokine release. Recognition and expert management of a cytokine-release re- action may enable patients to be rechallenged with the mono-clonal antibody, potentially improving clinical outcome. The safety of rapid infusions of rituximab is under investiga- tion, and initial findings of several trials reported that after successful first-cycle dosing according to manufacturer’s protocol, subsequent doses may be delivered by rapid infusion. C ancer therapies administered by IV infusion may cause infusion reactions. Infusion reactions always involve the immune system; however, some (of-ten called anaphylactic) are allergic in nature and typically are mediated by immunoglobulin E (IgE), whereas others (anaphylactoid) are not true allergic reactions and are not mediated by IgE (Kemp, Lockey, & Simons, 2008). Regardless of whether the reaction is allergic or nonallergic, clinical manifestations are the same and require prompt, ac-curate assessment and astute management to prevent severe adverse events, which can include death. Understanding the pathophysiology underlying each infusion reaction will en-hance decision making regarding rechallenge, thus potentially improving treatment outcomes. Monoclonal antibodies are a valuable treatment component for many different types of cancers as well as nonmalignant disorders. Monoclonal antibodies also have a unique side-effect profile and generally are better tolerated than chemotherapy in the author’s experience. A distinctive side effect of monoclonal antibodies is the potential for nonallergic infusion reactions caused by cytokine release. Less frequently, monoclonal anti-bodies can cause allergic infusion reactions. Although severe infusion reactions are rare, nurses must be familiar with these adverse events and know how to identify patients at particular risk and take preventive measures. This article presents an overview of the pathophysiology of infusion reactions precipitated by monoclonal antibodies, par-ticularly rituximab. Rituximab serves as an example of a dru