BACKGROUND: Hypersensitivity reactions (HSR) to biologic drugs (BD) may limit their use in children with rheumatic diseases. We aimed to analyze the incidence and clinical characteristics of immediate type I (IgE/non-IgE) hypersensitivity reactions to BD and the risk factors for these reactions. METHODS: Children with rheumatic diseases using BD who were evaluated in the pediatric allergy department for possible drug hypersensitivity reaction (DHR) due to BD or any other drug were included in the study. RESULTS: One hundred and twenty-eight children (49.2% boys; 14.6 years [9.9-16.9 years] with juvenile idiopathic arthritis [58%], familial Mediterranean fever [14%], vasculitis [14%], and other diseases [14%]) had used eight different BD with 32 494 infusions/injections. Fifteen patients were evaluated for DHR [injection-site reactions [n = 4], adverse events [n = 2], drug hypersensitivity other than BD [n = 3], and immediate BD hypersensitivity [n = 6]). The incidence of immediate BD HSR was 4.7%, with a clinical presentation of anaphylaxis in 3.9% (tocilizumab [n = 3], rituximab [n = 2], positive skin test with culprit BD [n = 3]). Among patients with BD HSR, the median follow-up was longer (84.5 vs 54 months, P = .048), and renal (33.3% vs 4.1%, P = .002), hematologic involvement (16.7% vs 0, P < .001), and active disease (83.3% vs 13.9%, P < .001) were more common. Logistic regression analysis revealed that renal involvement, more than 14 hospitalizations per lifetime, and more than two different BD used were associated with BD hypersensitivity. CONCLUSION: The frequency of severe immediate HSR due to BD was shown to be 3.9% in children with rheumatic diseases. Children with active rheumatic disease and who have exposure to multiple BD should be monitored for BD HSR, particularly during intravenous BD infusions.
BACKGROUND:Hypersensitivity reactions (HSR) to biologic drugs (BD) may limit their use in children with rheumatic diseases. We aimed to analyze the incidence and clinical characteristics of immediate type I (IgE/non-IgE) hypersensitivity reactions to BD and the risk factors for these reactions. METHODS:Children with rheumatic diseases using BD who were evaluated in the pediatric allergy department for possible drug hypersensitivity reaction (DHR) due to BD or any other drug were included in the study. RESULTS: One hundred and twenty-eight children (49.2% boys; 14.6 years [9.9-16.9 years] with juvenile idiopathic arthritis [58%], familial Mediterranean fever [14%], vasculitis [14%], and other diseases [14%]) had used eight different BD with 32 494 infusions/injections. Fifteen patients were evaluated for DHR [injection-site reactions [n = 4], adverse events [n = 2], drug hypersensitivity other than BD [n = 3], and immediate BD hypersensitivity [n = 6]). The incidence of immediate BD HSR was 4.7%, with a clinical presentation of anaphylaxis in 3.9% (tocilizumab [n = 3], rituximab [n = 2], positive skin test with culprit BD [n = 3]). Among patients with BD HSR, the median follow-up was longer (84.5 vs 54 months, P = .048), and renal (33.3% vs 4.1%, P = .002), hematologic involvement (16.7% vs 0, P < .001), and active disease (83.3% vs 13.9%, P < .001) were more common. Logistic regression analysis revealed that renal involvement, more than 14 hospitalizations per lifetime, and more than two different BD used were associated with BD hypersensitivity. CONCLUSION: The frequency of severe immediate HSR due to BD was shown to be 3.9% in children with rheumatic diseases. Children with active rheumatic disease and who have exposure to multiple BD should be monitored for BD HSR, particularly during intravenous BD infusions.
Authors: Natalia Riva; Manuel Molina; Berta L Cornaló; María V Salvador; Andrea Savransky; Silvia Tenembaum; María M Katsicas; Marta Monteverde; Paulo Cáceres Guido; Marcela Rousseau; Raquel Staciuk; Agustín González Correas; Pedro Zubizarreta; Oscar Imventarza; Eduardo Lagomarsino; Eduardo Spitzer; Marcelo Tinelli; Paula Schaiquevich Journal: Front Pharmacol Date: 2022-01-26 Impact factor: 5.810
Authors: D Sofia Villacis-Nunez; Kassahun Bilcha; Mary Spraker; Kelly Rouster-Stevens; Anthony Cooley Journal: J Investig Med High Impact Case Rep Date: 2022 Jan-Dec
Authors: Gail H Deutsch; R Paul Guillerman; Johannes Birgmeier; Karthik Jagadeesh; Scott Canna; Grant Schulert; Vivian E Saper; Guangbo Chen; Robin Deterding; Jianpeng Xu; Ann N Leung; Layla Bouzoubaa; Khalid Abulaban; Kevin Baszis; Edward M Behrens; James Birmingham; Alicia Casey; Michal Cidon; Randy Q Cron; Aliva De; Fabrizio De Benedetti; Ian Ferguson; Martha P Fishman; Steven I Goodman; T Brent Graham; Alexei A Grom; Kathleen Haines; Melissa Hazen; Lauren A Henderson; Assunta Ho; Maria Ibarra; Christi J Inman; Rita Jerath; Khulood Khawaja; Daniel J Kingsbury; Marisa Klein-Gitelman; Khanh Lai; Sivia Lapidus; Clara Lin; Jenny Lin; Deborah R Liptzin; Diana Milojevic; Joy Mombourquette; Karen Onel; Seza Ozen; Maria Perez; Kathryn Phillippi; Sampath Prahalad; Suhas Radhakrishna; Adam Reinhardt; Mona Riskalla; Natalie Rosenwasser; Johannes Roth; Rayfel Schneider; Dieneke Schonenberg-Meinema; Susan Shenoi; Judith A Smith; Hafize Emine Sönmez; Matthew L Stoll; Christopher Towe; Sara O Vargas; Richard K Vehe; Lisa R Young; Jacqueline Yang; Tushar Desai; Raymond Balise; Ying Lu; Lu Tian; Gill Bejerano; Mark M Davis; Purvesh Khatri; Elizabeth D Mellins Journal: Ann Rheum Dis Date: 2019-09-27 Impact factor: 19.103