Urticaria and angiedema-like skin reactions in a patient treated with adalimumab

Abstract

Specific inhibition of the cytokine tumor necrosis factor alpha has resulted in significant clinical and laboratory improvement of patients with chronic inflammatory diseases of Th1 phenotype. Etanercept is a recombinant fusion protein of two p75 soluble receptors, while infliximab is a chimeric monoclonal antibody. Both have been considered to be immunogenic and cause various immune-mediated skin reactions. On the other hand, adalimumab, a human monoclonal antibody, was expected to cause little or no immune-mediated skin reactions. Herein, we report a patient with rheumatoid arthritis treated with adalimumab, who after the seventh injection, developed angiedema affecting the lips and face, as well as an urticaria-like skin reaction affecting the trunk. These reactions were followed by hypotension. The patient was treated appropriately and after 2 h, the rashes and the edema disappeared and the patient gradually recovered completely. Adalimumab was discontinued.

Hypersensitivity reaction against influenza vaccine in a patient with rheumatoid arthritis after the initiation of etanercept injections

“…9 In RA patients, treatment with TNF-α inhibitors, such as etanercept and adalimumab, has been shown to cause atopic dermatitis, which is mediated by Th2 mechanisms. 10,11 These findings are consistent with the antagonism that occurs between Th1-and Th2-mediated pathways. 12,13 In our case, Th2-mediated responses may have been augmented by treatment with etanercept, which is known to strongly suppress Th1 activity, thereby triggering an immediate hypersensitivity response.…”

Angioedema of the Periorbital Region that Developed during Treatment with Etanercept in a Case of Refractory Adult-Onset Still's Disease

“…Therefore, Th1 dominant rheumatic diseases such as RA can be improved and achieved to remission by treatment with TNF-α blockers. In addition, TNF-α blockers may augment Th2 responses because the balance between Th1 and Th2 is competitive (15,16). CD4 + cells that differentiate into Th2 cells secrete interleukin (IL)-4 and IL-13, which act on B cells to stimulate production of antibodies, such as IgE that bind to mast cells.…”

Allergy to monoclonal antibodies: cutting-edge desensitization methods for cutting-edge therapies

“…Although local reactions with hives, local swelling and pruritus are the most common allergic reaction with the injectable TNF-a inhibitors [19], systemic reactions after adalimumab administration have also been reported [20][21][22]. Skin testing has been used to document the IgE-mediated mechanism of reactions to both etanercept and adalimumab [19,21,23].…”