Abstract | OBJECTIVE: CASE SUMMARY: A 46-year-old Indian female with rheumatoid arthritis demonstrated distinct adverse reactions to all commercially available anti- tumor necrosis factor therapies, sulfasalazine, and hydroxychloroquine. Over a 4-year period her disease remained active during therapy with methotrexate and prednisone. Biologics were added sequentially, with development of intolerable reactions, first to infliximab (urticarial rash, infusion reactions) after 3 doses, and then to etanercept ( autoantibodies, worsening Raynaud's phenomenon, digital microinfarcts) after 1 year. Following 2 months of daily injections of anakinra, she experienced an immediate immunoglobulin E-mediated anaphylactic reaction within 20 minutes of an injection, as evidenced by positive testing to both anakinra and histamine with the skin prick method. The patient subsequently started adalimumab therapy, which was discontinued after the fourth dose due to the development of generalized hives. DISCUSSION: CONCLUSIONS: This unusual case of a patient with multiple drug allergies presents a difficult clinical scenario, which was unsuccessfully managed with multiple biologic therapies on a trial-and-error basis. In the future, pharmacogenetics may help to better identify individuals at risk for multiple drug reactions and preclude unnecessary exposure to potentially harmful therapeutic options in similar patients.
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Authors | Ditina Desai, Raphaela Goldbach-Mansky, Joshua D Milner, Ronald L Rabin, Keith Hull, Frank Pucino, Nona Colburn |
Journal | The Annals of pharmacotherapy
(Ann Pharmacother)
Vol. 43
Issue 5
Pg. 967-72
(May 2009)
ISSN: 1542-6270 [Electronic] United States |
PMID | 19417117
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Antirheumatic Agents
- Interleukin 1 Receptor Antagonist Protein
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Topics |
- Anaphylaxis
(chemically induced)
- Antirheumatic Agents
(adverse effects)
- Arthritis, Rheumatoid
(drug therapy, immunology)
- Drug Hypersensitivity
(etiology)
- Female
- Humans
- Interleukin 1 Receptor Antagonist Protein
(adverse effects)
- Middle Aged
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