Tocilizumab‑induced anaphylaxis in two patients with COVID‐19‐induced cytokine storm

Öz

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a zoonotic virus which was first discovered in Wuhan, the People’s Republic of China in December 2019 and has led to one of the greatest pandemics of world history in a short period of time. SARS-CoV-2 is a rapidly spreading infectious disease with a high mortality rate. The disease has a moderate and severe course in approximately 20% of the patients and mortality reaches up to 62% among these patients . The majority of the patients develop SARS-CoV-2-induced pneumonia and manifestations of pneumonia rapidly progress to respiratory failure. The treatment of COVID‐19‐induced cytokine storm is not definitive, several pharmacological agents have been tried and used. Tocilizumab (TCZ) is a promising agent that is used for the treatment of cytokine storm. TCZ is an IgG1 class recombinant humanized monoclonal antibody against interleukin-6 (IL-6) receptor [4].However, potential IgE-mediated immunological reactions against this drug, especially anaphylaxis, may deprive these patients of an important treatment option for the treatment of COVID-19-induced cytokine storm. Although TCZ-induced anaphylaxis has been reported in the literature as case reports of indicated rheumatic diseases, TCZ-induced anaphylaxis has not yet been reported in patients using TCZ for PCR positive COVID‐19‐induced cytokine storms. In this case series, we aimed to represent cases of anaphylaxis which developed in two different patients using TCZ for COVID-19-induced cytokine storm.

Anahtar Kelimeler

• anaphylaxis
• COVID‐19
• cytokine storm
• drug allergy
• Tocilizumab

Kaynakça

1. 1. Xu X, Han M, Li T, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci U S A. 2020 May 19;117(20):10970-10975. doi: 10.1073/pnas.2005615117. PubMed PMID: 32350134; PubMed Central PMCID: PMCPMC7245089.
2. 2. Zu ZY, Jiang MD, Xu PP, et al. Coronavirus Disease 2019 (COVID-19): A Perspective from China. Radiology. 2020 Aug;296(2):E15-E25. doi: 10.1148/radiol.2020200490. PubMed PMID: 32083985; PubMed Central PMCID: PMCPMC7233368.
3. 3. Qin C, Zhou L, Hu Z, et al. Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020 Jul 28;71(15):762-768. doi: 10.1093/cid/ciaa248. PubMed PMID: 32161940; PubMed Central PMCID: PMCPMC7108125.
4. 4. Salmon JH, Perotin JM, Morel J, et al. Serious infusion-related reaction after rituximab, abatacept and tocilizumab in rheumatoid arthritis: prospective registry data. Rheumatology (Oxford, England). 2018 Jan 1;57(1):134-139. doi: 10.1093/rheumatology/kex403. PubMed PMID: 29069471; eng.
5. 5. Worm M, Eckermann O, Dolle S, et al. Triggers and treatment of anaphylaxis: an analysis of 4,000 cases from Germany, Austria and Switzerland. Dtsch Arztebl Int. 2014 May 23;111(21):367-75. doi: 10.3238/arztebl.2014.0367. PubMed PMID: 24939374; PubMed Central PMCID: PMCPMC4075276.
6. 6. Park EH, Lee EY, Shin K, et al. Tocilizumab-induced anaphylaxis in patients with adult-onset Still's disease and systemic juvenile idiopathic arthritis: a case-based review. Rheumatology international. 2020 May;40(5):791-798. doi: 10.1007/s00296-019-04456-9. PubMed PMID: 31598752.
7. 7. Salmon JH, Perotin JM, Morel J, et al. Serious infusion-related reaction after rituximab, abatacept and tocilizumab in rheumatoid arthritis: prospective registry data. Rheumatology (Oxford, England). 2018 Jan 1;57(1):134-139. doi: 10.1093/rheumatology/kex403. PubMed PMID: 29069471.
8. 8. Tetu P, Hamelin A, Moguelet P, et al. Management of hypersensitivity reactions to Tocilizumab. Clin Exp Allergy. 2018 Jun;48(6):749-752. doi: 10.1111/cea.13142. PubMed PMID: 29603809.

9. 9. Yasuoka R, Iwata N, Abe N, et al. Risk factors for hypersensitivity reactions to tocilizumab introduction in systemic juvenile idiopathic arthritis. Mod Rheumatol. 2019 Mar;29(2):324-327. doi: 10.1080/14397595.2018.1457490. PubMed PMID: 29578355.
10. 10. Galvao VR, Castells MC. Hypersensitivity to biological agents-updated diagnosis, management, and treatment. J Allergy Clin Immunol Pract. 2015 Mar-Apr;3(2):175-85; quiz 186. doi: 10.1016/j.jaip.2014.12.006. PubMed PMID: 25754718.