Severe anaphylactic reaction during the second infusion of infliximab in a patient with psoriatic arthritis.

A 33-yer-old woman with no history of atopy, diagnosed of psoriatic arthritis, received 200 mg I.V. infliximab, with previous oral administration of loratadine and betamethasone, that was well tolerated. Two minutes after a second infusion two weeks later, with the same pretreatment, the patients suffer dyspnea, laryngeal spasm, generalized tremor, vomiting, hypotension, sinusal tachycardia, anxiety and hyposemia. She recovered in 45 minutes, after the administration of I.V. hydrocortisone, chloropyramine, adrenaline and oxygen. Several reports of infliximab-induced anaphylactic reactions have been published, especially in patients with Crohn's disease, that have been attributed to a type I (acute or delayed) hypersensitivity reaction mechanism.