T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab.



Hammond, Sean, Olsson-Brown, Anna, Gardner, Joshua, Thomson, Paul ORCID: 0000-0001-5431-0459, Ali, Serat-E ORCID: 0000-0002-9806-8796, Jolly, Carol, Carr, Dan ORCID: 0000-0001-8028-4282, Ressel, Lorenzo, Pirmohamed, Munir ORCID: 0000-0002-7534-7266 and Naisbitt, Dean
(2021) T cell mediated hypersensitivity to previously tolerated iodinated contrast media precipitated by introduction of atezolizumab. Journal for immunotherapy of cancer, 9 (5).

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Abstract

Many adverse reactions associated with immune checkpoint inhibitor (ICI) treatments are immunologically driven and may necessitate discontinuation of the ICI. Herein, we present a patient who had been administered the radio contrast media amidotrizoate multiple times without issue but who then developed a Stevens-Johnson syndrome reaction after coadministration of atezolizumab. Causality was confirmed by a positive re-challenge with amidotrizoate and laboratory investigations that implicated T cells. Importantly, the introduction of atezolizumab appears to have altered the immunologic response to amidotrizoate in terms of the tolerance-elicitation continuum. Proof of concept studies demonstrated enhancement of recall responses to a surrogate antigen panel following <i>in-vitro</i> (healthy donors) and <i>in-vivo</i> (ICI patients) administrations of ICIs. Our findings highlight the importance of considering all concomitant medications in patients on ICIs who develop immune-mediated adverse reactions. In the event of some immune-related adverse reactions, it may be critical to identify the culprit antigen-forming entity that the ICIs have altered the perception of rather than simply attribute causality to the ICI itself in order to optimize both patient safety and treatment of malignancies.

Item Type: Article
Uncontrolled Keywords: T-Lymphocytes, Humans, Carcinoma, Renal Cell, Kidney Neoplasms, Stevens-Johnson Syndrome, Diatrizoate, Adrenal Cortex Hormones, Contrast Media, Risk Factors, Predictive Value of Tests, Male, Antibodies, Monoclonal, Humanized, Immune Checkpoint Inhibitors
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 16 Jun 2021 08:18
Last Modified: 14 Jan 2022 04:10
DOI: 10.1136/jitc-2021-002521
Open Access URL: http://doi.org/10.1136/jitc-2021-002521
URI: https://livrepository.liverpool.ac.uk/id/eprint/3126545