Reactions 1474, p19 - 19 Oct 2013

SEtanercept

Anaphylaxis in paediatric patients: 2 case reportsA 10-year-old boy and a 15-year-old girl developed

anaphylaxis while receiving SC injections of etanercept forjuvenile idiopathic arthritis (JIA).

The boy, who presented to an emergency department withan allergic reaction, had been receiving etanercept 25mgweekly. Immediately after his fifth injection, he had developeditching and mild periorbital swelling. The next day, he haddeveloped a rash, nausea and difficulty breathing. Onexamination, he had generalised urticaria, diffuse facialoedema and mild angioedema. Etanercept was withdrawn,and he received epinephrine [adrenaline], sodium chloride,prednisolone, diphenhydramine and ranitidine. His swellingand respiratory distress resolved; however, his facial rashpersisted throughout his hospitalisation. At last follow-up, hewas receiving methotrexate and adalimumab with no adverseevents.

The girl began receiving etanercept 20mg twice weekly.Within minutes of her third injection, she developed dyspnoeaand a generalised urticarial rash. She received antihistaminesand prednisone with rapid improvement of her symptoms, andan allergic reaction was considered likely. Etanercept waswithdrawn, and she later received methotrexate andadalimumab without adverse events.

Author comment: "Herein, we report 2 cases ofanaphylaxis associated with etanercept injection in childrenwith JIA."Crayne CB, et al. Anaphylaxis to etanercept in two children with juvenileidiopathic arthritis. . JCR: Journal of Clinical Rheumatology 19: 129-131, No. 3,Apr 2013. Available from: URL: http://dx.doi.org/10.1097/RHU.0b013e318285f1e9 - Germany 803094393

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