Injection-site reaction to etanercept: role of skin test in the diagnosis of such reaction and successful desensitization.

摘要

Anti-tumor necrosis factor (TNF) treatment, etanercept, infliximab, and ada-limumab, is recommended for ankylosing spondylitis (AS) with persistent disease activity despite conventional treatments (1-3). Injection-site reactions are the most common adverse reaction to etanercept; however, the mechanism underlying these reactions remains unclear (4). A 28-year-old man with AS was treated with Humira (40 mg/0.8 ml, Ada-limumab) subcutaneous injections and developed local swelling, diffuse itching, and shortness of breath after 26th injections, prompting drug discontinuation. He received salicylazosulfapyridine 1500 mg/day and indomethacin 50 mg/ day for 3 months without benefit and switched to Enbrel (25 mg etanercept) 25 mg subcutaneously twice weekly. He tolerated injections for 3 months and within 10-15 min of the 22nd injection developed local pruritus, redness and swelling 10 cni in diameter at the site of injection, followed by whole body urticaria and pruritus.