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 1 . 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 2 . The majority of the patients develop SARS-CoV-2-induced pneumonia and manifestations of pneumonia rapidly progress to respiratory failure. In severe Covid pneumonia, it has been demonstrated that increased plasma concentrations of cytokines including interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and IL-12 are involved in immune response and in cytokine storm caused by the increase in these cytokines lead to mortality 1, 3 . 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 IL-6 receptor 3 . It has then been used for the treatment of rheumatic diseases. Due to its mechanism of action, TCZ treatment comes to the forefront particularly in cases of severe COVID-19-induced cytokine pneumonia presenting with cytokine storm 3 . 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 as case reports of indicated rheumatic diseases, TCZ-induced anaphylaxis has not yet been reported in patients using TCZ for SARS-CoV-2-induced cytokine storms 4 . In this case series, we aimed to represent cases of anaphylaxis which developed in two different patients using TCZ for SARS-CoV-2-induced cytokine storm.
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