The benefits afforded by tocilizumab (TCZ) in patients with adult-onset Still's disease (AOSD) and systemic juvenile idiopathic arthritis (SJIA) have been described in previous studies. However, few reports have evaluated severe hypersensitivity reactions (HSRs) to TCZ in patients with AOSD or SJIA. We describe three instances of TCZ-induced anaphylactic reactions in AOSD/SJIA patients, and review relevant prior reports on patients with various rheumatic diseases. Two of our cases exhibited shock and cardiovascular collapse; TCZ was discontinued in all three cases. All events occurred within 20 min of TCZ infusion, after at least three prior infusions, indicating an IgE-mediated mechanism and previous sensitization to TCZ. In all three cases, mild HSRs had been observed about 1 month before the anaphylactic events, but pre-medication with antihistamines and corticosteroids failed to prevent anaphylaxis. All three cases had active AOSD or SJIA disease, and were refractory to other immunosuppressive agents. It is essential to be aware that severe anaphylaxis to TCZ can develop in patients with active refractory AOSD or SJIA, and to be cautious when medicating certain patients. Anaphylaxis is a serious condition that can be fatal; TCZ infusion should not be re-challenged via pre-medication in patients who exhibited mild HSRs before TCZ without desensitization.

中文翻译：

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成年Still病和系统性幼年特发性关节炎患者使用Tocilizumab引起的过敏反应：基于病例的综述。

在先前的研究中已经描述了托珠单抗（TCZ）对成年性斯蒂尔病（AOSD）和系统性幼年特发性关节炎（SJIA）患者的益处。但是，很少有报告评估了AOSD或SJIA患者对TCZ的严重超敏反应（HSR）。我们描述了AOSD / SJIA患者中TCZ引起的过敏反应的三种情况，并回顾了有关各种风湿病患者的相关先前报道。我们的两个病例表现出休克和心血管衰竭；TCZ在所有这三种情况下均已终止。所有事件均发生在至少三次先前的输注之后的TCZ输注的20分钟内，表明IgE介导的机制和先前对TCZ的致敏作用。在这三种情况下，在过敏反应发生前约1个月都观察到了轻度HSR，但用抗组胺药和皮质类固醇的药物前治疗未能预防过敏反应。这三例均患有活动性AOSD或SJIA疾病，并且对其他免疫抑制剂无效。必须意识到在活动性难治性AOSD或SJIA患者中会发生严重的TCZ过敏反应，在治疗某些患者时要谨慎。过敏反应是一种严重的疾病，可能致命。对于在TCZ之前表现出轻度HSR而未脱敏的患者，不应通过用药前重新挑战TCZ输液。并且在服药某些患者时要谨慎。过敏反应是一种严重的疾病，可能致命。对于在TCZ之前表现出轻度HSR而未脱敏的患者，不应通过用药前重新挑战TCZ输液。并且在服药某些患者时要谨慎。过敏反应是一种严重的疾病，可能致命。对于在TCZ之前表现出轻度HSR而未脱敏的患者，不应通过用药前重新挑战TCZ输液。