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Hypersensitivity reactions in the form of anaphylaxis: 7 case reports In a retrospective chart review of 53 paediatric patients treated with rituximab or tocilizumab between January 2010 and December 2018, 7 patients (5 girls and 2 boys) aged 2.5–16.7 years were described, who developed hypersensitivity reactions in the form of anaphylaxis during treatment with rituximab or tocilizumab. The patients started receiving rituximab infusions (2 patients) or tocilizumab infusions (5 patients) for polyarteritis nodosa, polyarticular juvenile idiopathic arthritis, systemic juvenile idiopathic arthritis, systemic lupus erythematosus or granulomatous polianjiitis [dosages not stated]. Prior to receiving rituximab or tocilizumab, all patients were premedicated with paracetamol and unspecified antihistamines. However, after 2–5 doses, the patients developed hypersensitivity reactions in the form of grade II/III anaphylaxis, which manifested as urticaria, angioedema, wheezing, cough and hypotension (1 patient), pruritus, angioedema, wheezing, cough, cyanosis and hypotension (1 patient), urticaria, dyspnoea, wheezing and tachycardia (1 patient), angioedema, cough, wheezing and chest pain (1 patient), urticaria, dyspnoea, wheezing and tachycardia (1 patient), urticaria, dyspnoea, abdominal pain and hypotension (1 patient), and pruritus, urticaria, dyspnoea, rhinitis, wheezing and tachycardia (1 patient). The rituximab and tocilizumab infusions were discontinued for all patients, and they were treated with methylprednisolone and hydroxyzine. All patients eventually made a complete recovery. Thereafter, 4 patients underwent skin tests, which showed positive results for tocilizumab hypersensitivity (3 patients) or rituximab hypersensitivity (1 patient). Five patients subsequently underwent successful immunological desensitisation, during which, one patient developed another episode of anaphylaxis at the fifth desensitisation that required treatment with epinephrine [adrenaline], hydroxyzine, methylprednisolone and salbutamol, while another patient developed urticaria that resolved with unspecified antihistamines. Demir S, et al. Desensitisation overcomes rituximab- and tocilizumab-related immediate hypersensitivity in childhood. Clinical and Experimental Rheumatology 38: 552-557, 803506592 No. 3, May-Jun 2020. Available from: URL: https://www.clinexprheumatol.org/a.asp?IDArchivio=236

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Reactions 17 Oct 2020 No. 1826