Successful rapid subcutaneous desensitization to Anakinra in a case of delayed-type hypersensitivity reaction

Drug hypersensitivity reactions may deprive patients of drug therapy. Successful desensitization protocols have been reported for common drugs and now for monoclonal antibodies^1,2. A 24 year-old woman followed for refractory adult-onset Still's disease was treated with anakinra (Kineret^®) subcutaneously (100mg each day) leading to rapid clinical improvement of her symptoms. However, one month later, she developed severe, symmetrical, erythematous skin plaques on the lower back and legs (Fig. 1a). Pathological examination of a skin lesional biopsy showed the presence of a perivascular mononuclear infiltrate associated with an inflammatory infiltrate localized at the dermal epidermal junction suggesting a lichenoid pattern (Fig 1b).

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