Delayed allergic hypersensitivity to anakinra (Kineret®)

We describe a ease of delayed allergic hypersensitivity to anakinra in a 48-year-old patient with rheumatoid arthritis. Over a period of 15 months, the disease remained active despite treatment based on colchimax, allopurinol, nonsteroidal anti-inflammatory drugs, corticosteroids and methotrexate. Treatment with anakinra administered by subcutaneous injection was started in September 2011. After ten days, a maculopapular non-itchy rash was observed at the injection site. Treatment has not been stopped because reactions at the injection sites, one of the most common side effects, are well described in the drug leaflet and in the medical literature. After three weeks of daily injections of anakinra, the patient developed a generalized itchy rash without fever or desquamation but with moderate disturbance of liver function and mild eosinophilia. The eruption decreased rapidly in the 48 hours after discontinuing anakinra. Allergy tests showed positive intradermal reactions, confirming the diagnosis of allergic delayed hypersensitivity to anakinra. (C) 2015 Elsevier Masson SAS. All rights reserved.