First Successful Protocol for Desensitizing Patients Allergic to Anti-CGRP Drug Eptinezumab | Research

The takeaway

A 10-step hospital-based desensitization protocol enabled two patients with hypersensitivity reactions to eptinezumab to safely receive the anti-CGRP migraine drug, with skin tests suggesting non-IgE mechanisms.

First protocol
The first published desensitization protocol for any anti-CGRP monoclonal antibody, enabling continued treatment for allergic patients

What the researchers found

Two patients with eptinezumab hypersensitivity reactions had negative skin tests (non-IgE mechanism) and successfully completed a 10-step hospital-based desensitization protocol, enabling safe drug readministration.

Why it matters

For patients who react to anti-CGRP drugs but need them for migraine, desensitization could be the only way to continue this effective treatment class.

How the study worked

Two case reports with skin testing (prick and intradermal) followed by a 10-step graded-dose desensitization protocol for eptinezumab IV administration.

What this study cannot tell us

Only two patients. Non-IgE mechanism means desensitization may not work for true allergic reactions. Hospital-based protocol requires significant resources.

How to read the evidence

Two case reports demonstrating feasibility. Small but novel — establishes proof of concept for anti-CGRP drug desensitization.

When this study was published

Published in 2025.

The bigger picture

This establishes a protocol that could be adapted for hypersensitivity to other anti-CGRP antibodies (erenumab, fremanezumab, galcanezumab), expanding treatment access.

Questions still open

Could this protocol be adapted for other anti-CGRP antibodies?
What is the mechanism of eptinezumab hypersensitivity if not IgE-mediated?
Does desensitization need to be repeated with each infusion?

Common questions

What if I'm allergic to my anti-CGRP migraine drug?

This protocol shows that gradual dose escalation (desensitization) can enable safe readministration. It requires hospital monitoring but both patients in this report completed treatment without reactions.

Is this a true allergy?

Interestingly, skin tests were negative in both cases, suggesting the reactions are not classic IgE-mediated allergies. This is good news because non-IgE reactions are generally more amenable to desensitization.

Read the original research

First successful protocol for desensitization to eptinezumab.

Headache, 66(2), 556-559

View on PubMed ↗Publisher’s paper ↗

Citation

Gerard, Benoit; Praudel, Hubert; Lanteri-Minet, Michel; Van Obberghen, Elise; Rocher-Moreau, Fanny; Rousset, Johanna; Jacquier, Ulysse; Leroy, Sylvie; Delin, Margot. (2026). First successful protocol for desensitization to eptinezumab.. Headache, 66(2), 556-559. https://doi.org/10.1111/head.70000