A Patient with Local Hypersensitivity Reactions to Three TNF-α Inhibitors and Local/Systemic Hypersensitivity Reactions to Tocilizumab: Desensitization to Tocilizumab
Abstract
Tumor necrosis factor-alpha (TNF-α) inhibitors are effective alternatives for chronic inflammatory diseases. They are generally well tolerated;
however, they may lead to the immediate/delayed local or systemic hypersensitivity reactions (HSR). Tocilizumab is a monoclonal antibody against
interleukin 6 receptors. It is given both via intravenous (IV) and subcutaneous (SC) routes and there are limited data reporting that the overall
injection and/or infusion reaction rate to tocilizumab is estimated as 7-8%. Cross-reactivity between either TNF-α inhibitors or tocilizumab is not
expected. However, we herein present an unusual case of a patient who reacted with local injection site reactions (ISRs) to three TNF-α inhibitors,
adalimumab, etanercept, and golimumab. The patient then reacted with ISR and anaphylaxis to SC and IV tocilizumab, respectively. Skin prick tests
with all biologicals were negative but positive in early readings of intradermal testing. After all, tocilizumab was successfully administered via rapid
drug desensitization.
Keywords
TNF-α Inhibitors, Tocilizumab, Local Hypersensitivity Reactions, Anaphylaxis, Desensitization
Ethical Statement
Ethics
Informed Consent: Written informed consent for the
publication of this report was obtained from the patient by the
corresponding author.
Peer-review: Externally peer-reviewed.
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