Rashes immunoglobulin

Adalimumab (Humira) is a human immunoglobulin Gj monoclonal TNF-a antibody. The binding of adalimumab results in inactivation of the proinflammatory cytokine TNF-a. It is indicated for psoriatic arthritis and treatment of adults with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy. The recommended dose for psoriatic arthritis is 40 mg subcutaneously every other week. The recommended dose for adults with plaque psoriasis is an initial dose of 80 mg, followed by 40 mg every other week starting 1 week after the initial dose. The most common adverse reactions are infections (e.g., upper respiratory, sinusitis), injection site reactions, headache, and rash. 

Adverse reactions occurring in 3% or more of patients with RA include the following Nausea, dyspepsia, rash, headache, abdominal pain, vomiting, fever, dizziness, stomatitis, pruritus, abnormal liver function tests, and leukopenia. One report showed a 10% rate of immunoglobulin suppression, which was slowly reversible and rarely accompanied by clinical findings. 

Idiosyncratic dmg reactions (IDRs) are most commonly characterized by a reaction involving fever or rash, with or without internal organ involvement. The spectrum of responses ranges from a minor rash, to potentially fatal toxic epidermal necrosis and Stevens-Johnson syndrome. Immunoglobulin E (IgE)-mediated anaphylactic shock, occasional joint pain, hepatotoxicity or nephrotoxicity are also well documented [24]. The frequency of such reactions are unknown but estimated to be between 1 1000 and 1 10000 exposures and may be enhanced on re-challenging susceptible individuals with the same dmg. 

About 30% of patients develop rashes with the first 1000 mg treatment this incidence decreases to about 10% with the second infusion and progressively decreases with each course of therapy thereafter. These rashes do not usually require discontinuation of therapy although urticarial or anaphylactoid reactions, of course, preclude further therapy. Immunoglobulins (particularly IgG and IgM) may decrease with repeated courses of therapy and infections can occur, although they do not seem directly associated with the decreases in immunoglobulins. Rituximab has not been associated with activation of tuberculosis, nor with the occurrence of lymphomas or other tumors (see Chapter 55). Other adverse effects, eg, cardiovascular events, are rare. 

Skin reactions to intravenous immunoglobulin are rare (52,93-95). Other reported reactions include urticaria, maculopapular rashes, petechiae, eczema, and erythema multiforme (31,96). 

Howse M, Bindoff L, Carmichael A. Facial vasculitic rash associated with intravenous immunoglobulin. BMJ 1998 317(7I68) 1291. 

Acute and chronic viral hepatitis are associated with a myriad of extrahep-atic tissue injuries, not all of which are directly related to the cytotoxic effects of HBV and HCV [35, 36], These include skin rashes and urticarial reactions in about 5% of patients with viral hepatitis [37 10], We investigated the possibility that protein Fv purified from patients suffering from HCV infection can activate basophils and mast cells purified from human lung and skin tissues. We found that protein Fv purified from stool extracts of patients with HCV infection induced histamine release from human basophils [32, 41]. Interestingly, the histamine-releasing activity of protein Fv was superimposible with its immunoglobulin-binding property (fig. 2). 

Hypersensitivity reactions include morbilliform rash in 2—5% of patients and occasionally more serious skin reactions, including Stevens-Johnson syndrome. Systemic lupus erythematosus and potentially fatal hepatic necrosis have been reported rarely. Hematological reactions include neutropenia and leucopenia, or more rarely, red-cell aplasia, agranulocytosis, and thrombocytopenia Lymphadenopathy is associated with reduced immunoglobulin A (IgA) production. Hypoprothrombinemia and hemorrhage have occurred in the newborns of mothers who received phenytoin during pregnancy vitamin K is effective treatment or prophylaxis. 

Chat J, Maimaigudi BM, Xu L, Uetiecht J (2008) Demonstration of the metabolic pathway responsible for nevirapine-induced skin rash. Chem Res Toxicol 21 1862-1870 Claes P, Winizen M, Allard S et al (2004) Nevirapine-induced toxic epidermal necrolysis and toxic hepatitis treated successfully with a combination of intravenous immunoglobulins and N-acetylcysteine. Eur J Intern Med 15 255-258... 

Allergy a hypersensitivity of the immune apparatus s pathological immune reaction induced either by antibodies (immediate hypersensitivity) or by lymphoid cells (delayed type A.). Unlike the delayed type, immediate hypersensitivity can be passively transmitted in the serum. Symptoms of immediate hy-peisensitivity begin shortly after contact and decay rapidly, but delayed type symptoms do not attain a maximum for 24-48 hours then decline slowly over days or weeks Examples of immediate type A. are anaphylaxis the Arthus reaction and serum sickness. The best known A., anaphylaxia, can occur as a local (cutaneous) reaction (e.g. a rash with blisters) or as a systemic reaction (anaphylactic shock). Asthma, hay fever and nettle rashes are also examples of local anaphylactic reactions which are induced by reagins (see Immunoglobulins IgE). Only primates can be sensitized by injection with human reagins. An example of delayed type A. is the tuberculin reaction, which is based on a cellular immune response. 

Skin Cutaneous reactions that are associated with intravenous immunoglobulin include erythema at the injection site, rashes, urticaria [40 ], and eczema [43 ]. 

A 34-year-old woman was given intravenous immunoglobulin for severe fetal erythrocyte allo-immunization and developed a self-limiting maculopapular rash, which was treated with oral promethazine 10 mg and resolved within 24 hours [59 ]. Previous and subsequent intravenous immunoglobulin treatments were not associated with adverse reactions. 

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