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Tocilizumab-induced anaphylaxis in patients with adult-onset Still’s disease and systemic juvenile idiopathic arthritis: a case-based review

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Abstract

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.

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Acknowledgements

This article was reviewed by English editing service, Textcheck http://www.textcheck.com.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea

    Eun Hye Park

  2. Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea

    Eun Young Lee

  3. Divison of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Hospital Boramae Medical Center, Seoul, South Korea

    Kichul Shin

  4. Department of Rheumatology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea

    Hyoun-Ah Kim

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  1. Eun Hye Park
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EYL and H-AK devised the project and the main conceptual ideas. EHP, H-AK, and KS interpreted the results and wrote the paper. All authors critically revised the manuscript at all stages of its production, final approval of manuscript, and review of literature.

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Correspondence to Hyoun-Ah Kim.

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Park, E.H., Lee, E.Y., Shin, K. et al. Tocilizumab-induced anaphylaxis in patients with adult-onset Still’s disease and systemic juvenile idiopathic arthritis: a case-based review. Rheumatol Int 40, 791–798 (2020). https://doi.org/10.1007/s00296-019-04456-9

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  • DOI: https://doi.org/10.1007/s00296-019-04456-9

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