{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T22:32:53Z","timestamp":1790721173832,"version":"4.1.0"},"reference-count":9,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["U01AI181927"],"award-info":[{"award-number":["U01AI181927"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01HS030234"],"award-info":[{"award-number":["R01HS030234"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp;amp; Neck"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Alpha\u2010gal syndrome is an allergic condition resulting from the bite of the Lonestar tick in the southeastern US that leads to sensitization to mammalian products containing the oligosaccharide galactose\u2010alpha\u20101,3\u2010galactose (alpha\u2010gal). Cetuximab is a chimeric monoclonal antibody that contains alpha\u2010gal and can lead to allergic reactions in individuals with alpha\u2010gal syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 66\u2010year\u2010old with metastatic squamous cell carcinoma of the right tonsil with involvement of the lung and liver was planned to receive palliative therapy with cetuximab. He was screened for alpha\u2010gal sensitization and found to have elevated specific IgE to alpha\u2010gal but had not had adverse reactions to mammalian products previously. He was referred to our allergy clinic for further recommendations to minimize the risk of a hypersensitivity reaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>He received his first dose as a graded challenge with cetuximab. Shortly after increasing the rate of his infusion to the second step of his challenge, the patient developed flushing, disseminated urticaria, and labored breathing. The remainder of his first dose and subsequent treatments were administered via a one\u2010bag desensitization protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case suggests caution with the use of cetuximab in those with asymptomatic alpha\u2010gal sensitization, along with the potential utility of graded challenge in a closely monitored setting, such as the ICU, to diagnose and desensitize to manage such patients in the future.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.70030","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:32:05Z","timestamp":1756377125000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Cetuximab Hypersensitivity in the Setting of Asymptomatic Alpha\u2010Gal Sensitization"],"prefix":"10.1002","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9880-0649","authenticated-orcid":false,"given":"Alexander G.","family":"Emerson","sequence":"first","affiliation":[{"name":"Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Mundy","sequence":"additional","affiliation":[{"name":"Outpatient Oncology Pharmacy, Department of Pharmaceutical Services Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara A.","family":"Murphy","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cosby A.","family":"Stone","sequence":"additional","affiliation":[{"name":"Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,28]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.alit.2019.04.001"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa074943"},{"issue":"9","key":"e_1_2_7_4_1","first-page":"S3","article-title":"Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: General Concepts","volume":"8","author":"Broyles A. D.","year":"2020","journal-title":"Journal of Allergy and Clinical Immunology"},{"key":"e_1_2_7_5_1","unstructured":"Eli Lilly and Company \u201cCetuximab. Package Insert \u201d 2019."},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2021.12.789"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2019.09.017"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2018.06.005"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2016.10.037"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anai.2022.07.010"}],"container-title":["Head &amp; Neck"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70030","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hed.70030","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70030","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T06:00:23Z","timestamp":1770789623000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hed.70030"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,28]]},"references-count":9,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1002\/hed.70030"],"URL":"https:\/\/doi.org\/10.1002\/hed.70030","archive":["Portico"],"relation":{},"ISSN":["1043-3074","1097-0347"],"issn-type":[{"value":"1043-3074","type":"print"},{"value":"1097-0347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,28]]},"assertion":[{"value":"2025-05-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-28","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}