etd Ege Tıp Dergisi 1016-9113 2147-6500 Ege Üniversitesi 10.19161/etd.648098 Hypersensitivity reactions to TNF-α inhibitors TNF-Alfa Inhibitörleri Ile Tedavi Seyrinde Gelişen Alerjik Reaksiyonlar https://orcid.org/0000-0002-7884-0830 Bavbek Sevim Ankara Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları Anabilim Dalı 10 25 2019 1 5 10 19 2018 08 15 2019 Copyright © 1962, Ege Tıp Dergisi 1962 Ege Tıp Dergisi

Patients with chronic inflammatory and autoimmune diseases are repeatedly exposed to TNF-α inhibitors. Currently five TNF-α inhibitors such as infliximab, etanercept, adalimumab, golimumab and certolizumab are available. Although these agents are generally well tolerated and safe, systemic such as urticaria, angioedema and anaphylaxis or local hypersensitivity reactions as local injection site reaction have been reported with the use of these drugs. Intravenous or subcutaneous rapid drug desensitization is a valid therapeutic option to preclude their use in sensitized patients.

Kronik romatizmal ve alerjik hastalıkların tedavisinde TNF- α inhibitörleri sıklıkla kullanılır. Şu anda kullanımda olan beş TNF-alfa inhibitörü mevcuttur. Bunlar; infliximab, adalimumab, etanercept, golimumab, certolizumab pegol’dür. Bu ilaçlar genelde güvenlidirler ve iyi tolere edilirler ancak sistemik veya lokal enjeksiyon yeri reaksiyonu gibi aşırı duyarlık reaksiyonuna neden olabilirler. Intravenöz veya subkutan ilaç desensitizasyonu bu durumlarda etkin ve güvenli bir tedavi seçeneğidir.

 TNF-α inhibitörü enjeksiyon yeri reaksiyonu aşırı duyarlık reaksiyonu biyolojik ajanlar desensitizasyon. TNF-α inhibitors injection site reaction systemic hypersensitivity reaction biological agents desensitization. Murdaca G, Colombo BM, Puppo F. Anti-TNF-alpha inhibitors: a new therapeutic approach for inflammatory immune-mediated diseases: an update upon efficacy and adverse events. Int J Immunopathol Pharmacol 2009;22(3):557-65. Tracey D, Klareskog L, Sasso EH, et al. Tumor necrosis factor antagonist mechanisms of action:A comprehensive review. Pharmacology & Therapeutics 2008;117:244-79. Corominas M, Gastaminza G, Lobera T. Hypersensitivity reactions to biological drugs. J Investig Allergol Clin Immunol 2014;24:212-25. Lichtenstein L, Ron Y, Kivity S, et al. Infliximab-Related Infusion Reactions: Systematic Review. J Crohns Colitis. 2015; 9(9):806-15. Murdaca G, Spanò F, Contatore M, et al. Immunogenicity of infliximab and adalimumab: what is its role in hypersensitivity and modulation of therapeutic efficacy and safety? Expert Opin Drug Saf. 2016;15(1):43-52. Culy CR, Keating GM. Etanercept: an updated review of its use in rheumatoid arthritis, psoriatic arthritis and juvenile rheumatoid arthritis. Drugs 2002;62:2493-537. Fleischmann R, Baumgartner SW, Weisman MH, et al. Long term safety of etancercept in elderly subjects with rheumatic diseases. Ann Rheum Dis 2006;65:379-84. Benucci M, Manfredi M, Demoly P, et al. Injection site reactions to TNF-α blocking agents with positive skin tests. Allergy 2008;63:138-9. Paltiel M, Gober LM, Deng A, et al. Immediate type I hypersensitivity response implicated in worsening injection site reactions to adalimumab. Arch Dermatol 2008;144(9):1190-4. Sator P. Safety and tolerability of adalimumab for the treatment of psoriasis: a review summarizing 15 years of real-life experience. Ther Adv Chronic Dis 2018;9(8):147-58. Santos RB, Galvão VR. Monoclonal Antibodies Hypersensitivity: Prevalence and Management. Immunol Allergy Clin North Am 2017;37(4):695-711. Ma X, Xu S. TNF inhibitor therapy for rheumatoid arthritis. Biomed Rep. 2013 Mar;1(2):177-84. Launois R, Avouac B, Berenbaum F, et al. Comparison of certolizumab pegol with other anticytokine agents for treatment of rheumatoid arthritis: a multiple-treatment Bayesian metaanalysis. J Rheumatol 2011;38(5):835-45. Patel SV, Khan DA. Adverse Reactions to Biologic Therapy. Immunol Allergy Clin North Am 2017 May;37(2):397-412. Borra´s-Blasco J, Navarro-Ruiz A, Borra´s C, et al. Adverse Cutaneous Reactions Induced by TNF-α Antagonist Therapy.Southern Med J 2009;102 (11): 1133-9. Wendling D, Verhoeven F, Guillot X, Prati C. Immunogenicity of TNF alpha inhibitors in rheumatology: many questions, enough answers? Expert Opin Drug Saf 2017;16(1):1-3. Matucci A, Pratesi S, Petroni G, et al. Allergological in vitro and in vivo evaluation of patients with hypersensitivity reactions to infliximab. Clin Exp Allergy 2013;43(6):659-64. Vultaggio A, Maggi E, Matucci A. Immediate adverse reactions to biologicals: from pathogenic mechanisms to prophylactic management. Curr Opin Allergy Clin Immunol 2011;11(3):262-8. Batycka-Baran A, Flaig M, Molin S, et al. Etanercept-induced injection site reactions: potential pathomechanisms and clinical assessment. Expert Opin Drug Saf 2012;11(6):911-21. Zeltser R, Valle L, Tanck C, et al. Clinical, histological, and immunophenotypic characteristics of injection site reactions associated with etanercept: a recombinant tumor necrosis factor alpha-receptor: Fc fusion protein. Arch Dermatol 2001;137(7):893-9. Bavbek S, Ataman S¸ Akıncı A, et al. Rapid subcutaneous desensitization for the management of local and systemic hypersensitivity reactions to etanercept and adalimumab in 12 patients. J Allergy Clin Immunol Pract 2015;3:629-32. Vultaggio A, Matucci A, Nencini F, Pratesi S, Maggi E. Skin testing and infliximab-specific antibodies detection as a combined strategy for preventing infusion reaction. Intern Emerg Med 2012; 7 (Suppl 2):77-9. Brennan PJ, Rodriguez Bouza T, et al. Hypersensitivity reactions to mAbs: 105 desensitizations in 23 patients, from evaluation to treatment. J Allergy Clin Immunol 2009;124(6):1259-66. Bavbek S, Aydın O, Ataman S, Cahill K, Castells M. Injection-site reaction to etanercept: role of skin test in the diagnosis of such reaction and successful desensitization. Allergy 2011:66(9):1256-7. Bavbek S, Ataman Ş, Bankova L, Castells M. Injection site reaction to adalimumab: positive skin test and successful rapid desensitization. Allergol Immunopathol 2012;41(3):204-6. Vultaggio A, Matucci A, Nencini F, et al. Hypersensitivity Reactions to Biologicals: True Allergy? Curr Treat Options Allergy 2016;3:147–157. Galvao VR, Castells MC. Hypersensitivity to biological agents-updated diagnosis, management, and treatment. J Allergy Clin Immunol Pract 2015;3:175–85. Brennan PJ, Rodriguez Bouza T, Hsu FI, et al. Hypersensitivity reactions to mAbs: 105 desensitizations in 23 patients, from evaluation to treatment. J Allergy Clin Immunol 2009;124:1259–66. Quercia O, Emiliani F, Foschi FG, et al. Adalimumab desensitization after anaphylactic reaction. Ann Allergy Asthma Immunol 2011;106:547-8. 2019; Cilt / Volume: 58 (Ek Sayı / Supplement) 5 Rodriguez Jimenez B, Dominquez-Ortega J. Successful adalimumab desensitization after generalized urticaria and rhinitis. J Investig Allergol Clin Immunol 2009;19:246-7. de la Varga Martínez, R, Gutierrez Fernandez D, Foncubierta Fernandez A, et al. Rapid subcutaneous desensitization for treatment of hypersensitivity reactions to etanercept in two patients with positive basophil activation test. Allergol Int 2017;66(2):357-9. Bavbek S, Lee MJ. Subcutaneous Injectable Drugs Hypersensitivity and Desensitization: Insulin and Monoclonal Antibodies. Immunol Allergy Clin North Am 2017;37(4):761-71.