Delayed urticaria during treatment with anti-CGRP monoclonal antibodies in migraine
Abstract
Objective: To characterize clinical presentation and management of urticaria associated with calcitonin gene-related peptide (CGRP) -targeting monoclonal antibodies (mAbs) for migraine prophylaxis.
Background: CGRP-targeting mAbs are effective in migraine prophylaxis, but have been associated with hypersensitivity reactions, including urticaria. The underlying mechanisms, risk factors, and therapeutic consequences of these anti-CGRP mAb-related hypersensitivity reactions remain poorly understood.
Methods: We performed a retrospective case series with descriptive analysis on five patients who developed urticaria after anti-CGRP mAb administration. Timing of reactions, history of urticaria, re-exposure strategies including premedication, and clinical outcomes were analyzed by chart review.
Results: Urticaria occurred after the first injection in three patients and after the third or sixth injection in two. Onset was delayed (12-48 h) in all patients, indicating a non-IgE-mediated hypersensitivity. Four of five patients had a prior history of urticaria. All patients were re-exposed: two to the same anti-CGRP mAb and three to a different. Three patients received H1-antihistamine premedication. All premedicated patients in this series tolerated re-exposure, irrespective of switching. One patient experienced worsening urticaria with repeated dosing without premedication despite negative allergy testing, but later tolerated the same anti-CGRP mAb with premedication. In contrast,…
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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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