{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:11:06Z","timestamp":1790683866783,"version":"4.1.0"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p>\n                    This case report describes a 51-year-old woman with recurrent cervical squamous cell carcinoma who developed acute anaphylactic shock within 5\u201310\u00a0min of initiating intravenous cadonilimab infusion. The physician\u2019s order was placed at 16:04; however, the actual bedside infusion was initiated at approximately 20:00 without routine premedication. Five minutes after infusion start, she presented with pruritus and multiple erythematous maculopapular rashes over the trunk, followed by dyspnea, generalized flushing, profound hypotension (68\/40\u00a0mmHg), oxygen desaturation (SpO\n                    <jats:sub>2<\/jats:sub>\n                    82%), and altered consciousness. The infusion was immediately discontinued. Emergency treatment included subcutaneous epinephrine 0.5\u00a0mg, intramuscular diphenhydramine 20\u00a0mg, intravenous dexamethasone 10\u00a0mg, aggressive fluid resuscitation, and supplemental oxygen. Because refractory hypotension persisted, intravenous norepinephrine (4\u00a0mg via continuous pump) was initiated and maintained for approximately 72\u00a0h. Hemodynamic stability was restored within 45\u00a0min. Comprehensive evaluation excluded infection, cardiogenic shock, pulmonary embolism, and cytokine release syndrome. The event fulfilled World Allergy Organization diagnostic criteria for anaphylaxis and was graded as Common Terminology Criteria for Adverse Events (CTCAE) v5.0 Grade 4. Causality assessment using the Naranjo scale yielded a score of 6, indicating a probable adverse drug reaction. The patient had a documented prior hypersensitivity to paclitaxel but no prior exposure to immune checkpoint inhibitors. Rechallenge was not attempted. Cadonilimab may rarely cause rapid-onset, life-threatening anaphylactic shock during the first infusion. Careful monitoring, immediate access to emergency management\u2014including vasopressor support\u2014and heightened awareness of bispecific antibody\u2013associated hypersensitivity are essential.\n                  <\/jats:p>","DOI":"10.3389\/fphar.2026.1834324","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T05:30:59Z","timestamp":1786339859000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Life-threatening anaphylactic shock induced by cadonilimab (AK104), a PD-1\/CTLA-4 bispecific antibody: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Zhiming","family":"Zheng","sequence":"first","affiliation":[{"name":"Xiaolan Clinical Institute of Shantou University Medical College","place":["Zhongshan, China"]},{"name":"Department of Pharmacy, Xiaolan People\u2019s Hospital of ZhongShan (The Fifth People\u2019s Hospital of ZhongShan)","place":["Zhongshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianrong","family":"Li","sequence":"additional","affiliation":[{"name":"Xiaolan Clinical Institute of Shantou University Medical College","place":["Zhongshan, China"]},{"name":"Department of Pharmacy, Xiaolan People\u2019s Hospital of ZhongShan (The Fifth People\u2019s Hospital of ZhongShan)","place":["Zhongshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Huang","sequence":"additional","affiliation":[{"name":"Xiaolan Clinical Institute of Shantou University Medical College","place":["Zhongshan, China"]},{"name":"Department of Pharmacy, Xiaolan People\u2019s Hospital of ZhongShan (The Fifth People\u2019s Hospital of ZhongShan)","place":["Zhongshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"314","DOI":"10.4161\/self.1.4.13904","article-title":"Immunogenicity of protein therapeutics: the key causes, consequences and challenges","volume":"1","author":"Baker","year":"2010","journal-title":"Self Nonself"},{"key":"B2","volume-title":"\u5361\u5ea6\u5c3c\u5229\u5355\u6297\u6ce8\u5c04\u6db2\u8bf4\u660e\u4e66(\u5f00\u5766\u5c3c\u00ae)","author":"Biopharma","year":"2022"},{"key":"B3","doi-asserted-by":"publisher","first-page":"100472","DOI":"10.1016\/j.waojou.2020.100472","article-title":"World allergy organization anaphylaxis guidance 2020","volume":"13","author":"Cardona","year":"2020","journal-title":"World Allergy Organ J."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2892","DOI":"10.2174\/138161208786369803","article-title":"Hypersensitivity to antineoplastic agents","volume":"14","author":"Castells","year":"2008","journal-title":"Curr. 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