A Patient with Local Hypersensitivity Reactions to Three TNF-α Inhibitors and Local/Systemic Hypersensitivity Reactions to Tocilizumab: Desensitization to Tocilizumab

Year 2022, Volume: 75 Issue: 1, 130 - 133, 30.06.2022

Sevim Bavbek Betül Özdel Öztürk , Nilay Orak Akbay Elif Er Gülbezer , Francesca Nencini Alessandra Vultaggio

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.

Üç TNF-α İnhibitörü ile Lokal ve Tosilizumab ile Lokal/Sistemik Aşırı Duyarlılık Reaksiyonu Gelişen Bir Hasta: Tosilizumab ile Desensitizasyon

Abstract

Tümör nekroz faktör-alfa (TNF-α) inhibitörleri, kronik enflamatuvar hastalıklar için etkili alternatiflerdir. Genellikle iyi tolere edilirler, ancak erken/geç
tip lokal veya sistemik aşırı duyarlılık reaksiyonlarına (ADR) yol açabilirler. Tosilizumab, interlökin-6 reseptörlerine karşı bir monoklonal antikordur.
Hem intravenöz (İV) hem de subkütan (SK) yolla verilir ve sınırlı sayıda çalışmada tosilizumab ilişkili enjeksiyon ve/veya infüzyon reaksiyon oranının
%7-8 olduğu bildirilmiştir. TNF-α inhibitörleri veya tosilizumab arasında çapraz reaktivite beklenmemektedir. Ancak biz burada olağan dışı bir olgu
olan üç TNF-α inhibitörü, adalimumab, etanersept ve golimumab, ile lokal enjeksiyon yeri reaksiyonu gelişen bir hasta sunduk. Hastada daha sonra
SK ve İV tosilizumab ile sırasıyla lokal enjeksiyon yeri reaksiyonu ve anafilaksi gelişti. Tüm biyolojik ajanlarla yapılan deri prick testleri negatif,
intradermal testlerin erken okumaları pozitifti. Bununla birlikte tosilizumab hızlı ilaç desensitizasyon yoluyla başarıyla uygulandı.

Keywords

TNF- α Inhibitörleri , Tosilizumab , Lokal Aşırı Duyarlılık Reaksiyonu , Anafilaksi , Desensitizasyon

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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