Biologic medications are an expanding field of therapeutics for various medical conditions including cancer and inflammatory diseases. Due to their targeted approach to therapy, biologics can be less toxic than traditional systemic medications. However, as use becomes more widespread, adverse effects from biologic administration have also become apparent. Immune-related adverse events are a common mechanism by which biologics can cause on-target immune-related toxicities and both immediate and delayed-type hypersensitivity reactions. Immediate hypersensitivity reactions can be mediated by cytokine release or antibody mediated reactions, while delayed-type hypersensitivity is most often caused by serum sickness-like reactions. Additionally, biologics used for treatment of cancer using checkpoint blockade and rheumatologic disease using cytokine blockade can result in autoimmunity. Finally, when inflammatory cytokines are targeted for treatment of autoimmune or autoinflammatory disease, the host immune defense can be compromised predisposing to secondary immunodeficiency. This review will discuss the mechanisms of these reactions and discuss examples of biologics implicated in each of these adverse events.

生物药物是治疗包括癌症和炎症性疾病在内的各种疾病的一个不断扩大的领域。由于其靶向治疗方法，生物制剂的毒性可能低于传统的全身药物。然而，随着使用变得更加广泛，生物给药的不利影响也变得明显。免疫相关不良事件是一种常见机制，生物制剂可通过该机制引起靶向免疫相关毒性以及即刻型和延迟型超敏反应。速发型超敏反应可由细胞因子释放或抗体介导的反应介导，而迟发型超敏反应最常由血清病样反应引起。此外，使用检查点阻断治疗癌症和使用细胞因子阻断治疗风湿病的生物制剂可导致自身免疫。最后，当炎症细胞因子被用于治疗自身免疫或自身炎症性疾病时，宿主免疫防御可能会受到损害，从而导致继发性免疫缺陷。本综述将讨论这些反应的机制，并讨论与这些不良事件有关的生物制剂的例子。