Reactions 1704, p18 - 2 Jun 2018 Recurrent injection site urticaria and IgE-mediated hypersensitivity to adalimumab: case report A 29-year-old woman developed recurrent injection site urticaria and IgE-mediated hypersensitivity to adalimumab during treatment with adalimumab [Humira] for spondylarthritis. The woman, who had spondylarthritis, was referred for suspected adalimumab allergy. She received SC adalimumab injection every 2 weeks before her pregnancy. Due to her pregnancy, adalimumab was withheld during pregnancy period. After her delivery, she re-started the same formulation of SC adalimumab injection every 2 weeks. But, she experienced progressive localised injection site pain and swelling 1 hour post each administration. She had persistent local induration for 3 to 4 days and it was reappearing after each injection despite altering injection sites. After receiving seventh dose, she was hospitalised for a progressive 12cm indurated and erythematous large local reaction, which started within an hour after SC injection on her right thigh. She was deemed to have injection site urticaria. Possible infection was excluded. The woman was treated with unspecified antihistamines and systemic corticosteroids. Adalimumab was discontinued and her symptoms resolved. She was suspected to have hypersensitivity to adalimumab. One month later, intradermal tests (IDT) and skin prick test (SPT) with adalimumab were done on the volar surface of her left arm. The IDT was positive with immediate wheal expansion from 7mm to 20mm, and SPT was negative. She was treated with unspecified antihistamines, but reported recurrent urticaria around her skin testing and also on previous injection site on her right thigh 1 hour later. Delayed IDT readings were found to be negative. The presence of a large local reaction, recall urticarial and positive immediate IDT suggested an IgE-mediated hypersensitivity to adalimumab. She was switched to secukinumab and reported no further reactions. Author comment: "We report the first case of biologics- related [recall Urticaria]". "However, she experienced progressive painful localized injection site swelling 1 hour after each administration." Li PH, et al. Recall Urticaria in Adalimumab Hypersensitivity. Journal of Allergy and Clinical Immunology: In Practice 6: 1032-1033, No. 3, Jun 2018. Available from: URL: http://doi.org/10.1016/j.jaip.2017.10.031 - Hong Kong 803323321 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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