Paltiel Michael, Gober Laura M, Deng April, Mikdashi Jamal, Alexeeva Irena, Saini Sarbjit S, Gaspari Anthony A
Department of Dermatology, University of Maryland, Baltimore, MD 21201, USA.
Arch Dermatol. 2008 Sep;144(9):1190-4. doi: 10.1001/archderm.144.9.1190.
Tumor necrosis factor (TNF) inhibitors such as adalimumab, etanercept, and infliximab play an increasingly important role in the management of a variety of chronic inflammatory disorders. With their increasing use, a wide spectrum of dermatological adverse effects, including injection site reactions and the development of dermatitis, have been recognized. Previous studies have implicated the role of the delayed-type hypersensitivity reaction in mediation of injection site reactions to etanercept. To our knowledge, there have been no published studies on immunologic mechanism of injection site reactions to adalimumab to date.
We describe 2 patients with a history of worsening injection site reactions to adalimumab. Findings from skin testing in both patients were suggestive of an immediate type I hypersensitivity reaction to adalimumab. A histamine release assay performed on peripheral blood leukocytes from both patients demonstrated significant histamine release on exposure to adalimumab. Furthermore, passive transfer of serum from one of the allergic patients to basophils from a nonatopic, healthy donor sensitized those cells to release significant amounts of histamine with exposure to adalimumab. Conclusion This study demonstrates that an IgE-mediated immediate type I hypersensitivity reaction plays a role in the mediation of worsening injection site reactions in some patients receiving adalimumab.
肿瘤坏死因子（TNF）抑制剂，如阿达木单抗、依那西普和英夫利昔单抗，在多种慢性炎症性疾病的治疗中发挥着越来越重要的作用。随着其使用的增加，包括注射部位反应和皮炎发生在内的广泛皮肤不良反应已被认识到。先前的研究表明迟发型超敏反应在介导依那西普注射部位反应中起作用。据我们所知，迄今为止尚无关于阿达木单抗注射部位反应免疫机制的已发表研究。
我们描述了2例对阿达木单抗注射部位反应恶化的患者。两名患者的皮肤试验结果提示对阿达木单抗存在速发型I型超敏反应。对两名患者外周血白细胞进行的组胺释放试验表明，暴露于阿达木单抗时组胺大量释放。此外，将一名过敏患者的血清被动转移至一名非特应性健康供体的嗜碱性粒细胞，使这些细胞在暴露于阿达木单抗时释放大量组胺。结论本研究表明，IgE介导的速发型I型超敏反应在一些接受阿达木单抗治疗的患者注射部位反应恶化的介导中起作用。
