[Delayed hypersensitivity to infliximab retreatment in two patients and literature review].

OBJECTIVE

To improve the understanding of severe anaphylactic reactions to infliximab retreatment.

METHODS

Delayed hypersensitivity to infliximab in two patients with ankylosing spondylitis who had previously received infliximab and resumed after discontinuation over 4 years were reported and the related literatures were reviewed.

RESULTS

Two patients (1 male, 1 female) who were diagnosed with ankylosing spondylitis for more than 10 years, both individuals had received infliximab treatment during a clinical trial approximately 4 - 5 years prior to further therapy.On day 6 after subsequent infusion, one patient had pruritic skin rash covering her whole body, followed by clustered, dyspnea, hypotension and anaphylactic shock, she was successfully treated with epinephrine and glucocorticoid. Another patient experienced a skin rash and itching 9 days after reinfusion, he was successfully treated with antihistaminics.

CONCLUSION

A distant infliximab retreatment is associated with high rates of reinfusion reactions, including fever, urticaria, myalgia, arthralgia, even hypotension, dyspnea, laryngeal edema and anaphylactic shock. We recommend careful monitoring of those patients who receive infliximab retreatment, particularly after a lengthy interval.