Fatal Infusion Reactions to Cetuximab: Role of Immunoglobulin E–Mediated

report a fatal hypersensitivity reaction to cetuximab in a 63-year-old patient with metastatic colon cancer and outlined a 0.1 % incidence of death in the literature. We greatly acknowledge the authors ’ desire to communicate the risk of fatal anaphylactic reaction with cetuximab. Over the past 2 years in our center in Tours, France, four instances of grade 4 anaphylactic reactions occurred in patients treated for head and neck cancer (locally advanced or metastatic), with one immedi-ately fatal; another patient died within 5 days (unpublished data). Seven lethal anaphylactic reactions were registered in a pharmacovigi-lance survey in France, based on spontaneous declarations (Grand-vuillemin et al, manuscript in preparation). Anaphylaxis to cetuximab is a problem that merits serious clinical attention. In the authors ’ words, “the pathogenic mechanisms underlying the development of this phenomenon remain to be elucidated.”1 They raise thehypothesisof immunoglobulin E (IgE) –independent mechanisms