We present tocilizumab desensitization of a 47-year-old woman affected by rheumatoid arthritis with full body delayed erythematous urticarial reaction. Skin test for tocilizumab gave cutaneous reaction after 6 h at 20 mg/mL. The schedule of desensitization was then adapted for non-immediate reaction. We prepared a desensitization procedure reaching the cumulative dose of 516 mg in 5 weeks. After 6 months, the repetition of skin tests had a negative result, with demonstration of tolerance induction. Today the patient has good control of the disease.
The current therapy with direct trombin inhibitors (DTI) is indicated for the prevention of stroke in non-valvular atrial fibrillation. Side effects are reported, particularly skin hypersensitivity, for this whole category of drugs as well as for other modern antiplatelet and anticoagulant drugs. For their clinical features, these reactions appear as delayed T-cell mediated drug hypersensitivity, but at present there are no diagnostic methods of investigation. We reported a case of delayed skin reaction to edoxaban and we found the non-irritant concentration for patch test in the whole category of drugs. The patch test resulted positive for edoxaban. A successive challenge with alternative DTIs and/or a switch to warfarin is proposed as alternative therapy.
An association between nausea and alcoholism (p=0.06), diarrhoea and diabetes mellitus (p=0.03), age (p=0.02) and treatment duration (p=0.01) was found. Furthermore, a relationship between vomiting and female gender (p=0.016) and smoking (p=0.017) was observed. No significant association was found between toxicity and the MTHFR 1298 and ABCB1 C3435T polymorphisms examined. Conclusion and relevance In conclusion, gastrointestinal toxicity events were associated with alcoholism, diabetes mellitus, age, treatment duration, female gender and smoking. No significant association was found between toxicity and the SNPs examined.
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