PMID- 21504597
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20110714
LR  - 20211020
IS  - 1752-1947 (Electronic)
IS  - 1752-1947 (Linking)
VI  - 5
DP  - 2011 Apr 19
TI  - Spondylarthritis presenting with an allergic immediate systemic reaction to 
      adalimumab in a woman: a case report.
PG  - 155
LID - 10.1186/1752-1947-5-155 [doi]
AB  - INTRODUCTION: The efficacy of adalimumab, a fully human anti-tumor necrosis 
      factor alpha recombinant antibody, has dramatically improved the quality of life of 
      patients with rheumatoid and psoriatic arthritis and Crohn's disease. Because it 
      is fully human, one should not expect immune reactions to this molecule. Adverse 
      reactions to adalimumab are limited mainly to injection site reactions and are 
      very common. Immediate systemic reactions are rarely reported. CASE PRESENTATION: 
      We report the case of a 61-year-old Caucasian woman who was treated with 
      adalimumab for spondylarthritis and developed injection site reactions after the 
      sixth dose. After a two-month suspension, she recommenced therapy and experienced 
      two systemic reactions. The first occurred after one hour with itching of the 
      palms and soles and angioedema of the tongue and lips. Thirty minutes after the 
      next dose the patient had itching of the palms and soles with diffusion to her 
      whole body, angioedema of the lips, dizziness and visual disturbances. A 
      skin-prick test and intra-dermal tests with adalimumab gave strong positive 
      results at the immediate reading. However, serum-specific immunoglobulin E (IgE) 
      to adalimumab were not detectable by using Phadia solid phase, especially 
      harvested for this case, in collaboration with our Immunology and Allergy 
      Laboratory Unit. Her total IgE concentration was 6.4 kU/L. CONCLUSION: We 
      describe what is, to the best of our knowledge, the first reported case of 
      immediate systemic reaction to adalimumab studied with a skin test giving 
      positive results and a serum-specific IgE assay giving negative results. The 
      mechanism of the reaction must be immunologic but not IgE-mediated.
FAU - Benucci, Maurizio
AU  - Benucci M
AD  - Allergy and Clinical Immunology Unit, Ospedale S, Giovanni di Dio, Via di 
      Torregalli 3, I-50143 Firenze, Italy. paopaocampi@gmail.com.
FAU - Manfredi, Mariangela
AU  - Manfredi M
FAU - Testi, Sergio
AU  - Testi S
FAU - Iorno, Maria L
AU  - Iorno ML
FAU - Valentini, Maurizio
AU  - Valentini M
FAU - Soldaini, Francesca
AU  - Soldaini F
FAU - Campi, Paolo
AU  - Campi P
LA  - eng
PT  - Journal Article
DEP - 20110419
PL  - England
TA  - J Med Case Rep
JT  - Journal of medical case reports
JID - 101293382
PMC - PMC3112110
EDAT- 2011/04/21 06:00
MHDA- 2011/04/21 06:01
PMCR- 2011/04/19
CRDT- 2011/04/21 06:00
PHST- 2009/10/24 00:00 [received]
PHST- 2011/04/19 00:00 [accepted]
PHST- 2011/04/21 06:00 [entrez]
PHST- 2011/04/21 06:00 [pubmed]
PHST- 2011/04/21 06:01 [medline]
PHST- 2011/04/19 00:00 [pmc-release]
AID - 1752-1947-5-155 [pii]
AID - 10.1186/1752-1947-5-155 [doi]
PST - epublish
SO  - J Med Case Rep. 2011 Apr 19;5:155. doi: 10.1186/1752-1947-5-155.