Bilateral parotidomegaly following anaphylaxis to infliximab

Anaphylaxis is highly likely when any one of the following 3 criteria are fulfilled 1. Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (e.g., generalized hives, pruritus or flushing, swollen lips / tongue / uvula) and at least one of the following: a. Respiratory compromise (e.g., dyspnea, wheeze / bronchospasm, stridor, reduced PEF, To the Editor:
b. Reduced BP or associated symptoms of end-organ dysfunction (e.g., hypotonia [collapse], old man who developed bilateralparotidomegaly after an infusion of in- 2. Two or more of the following that occur rapidly after exposure to a likely allergen for that patient (minutes to several hours): a. Involvement of the skin-mucosal tissue (e.g., generalized hives, itch / flush, swollen lips / b. Respiratory compromise (e.g., dyspnea, wheeze / bronchospasm, stridor, reduced PEF, c. Reduced BP or associated symptoms (e.g., hypotonia [collapse], syncope, incontinence) d. Persistent gastrointestinal symptoms (e.g., crampy abdominal pain, vomiting) tially presented with abdominal painand diarrhea, with inflammation of the 3. Reduced BP after exposure to known allergen for that patient (minutes to several hours): b. Adults: systolic BP of less than 90 mm Hg or greater than 30% decrease from that PEF, Peak expiratory flow; BP, blood pressure. FIGURE 1. Clinical criteria for diagnosing anaphylaxis.6
drocortisone 100 mg and prometha-zine 12.5 mg as premedication.
crosis factor alpha, as opposed to inflix- ϫ 8 cm, without associated lymphade- well tolerated and resulted in clinical lessness, throat tightness, and flushing be not straightforward, and this case il- cultation. Blood pressure, heart rate, re- negative, consistent with past infection.
bodies. Infusion reactions occur in 6%– ticaria, or tongue or facial angioedema.
spontaneously over a period of 6 weeks.
Ϸ1%.3 The majority of reactions are felt ruled out by a graded oral challenge.
Skin prick testing to neat infliximab was negative; however, this does not rule out defines anaphylaxis as “a severe, life- lateral swellings in the parotid areas.
laxis to a metabolite of infliximab (bro- persensitivity reaction.” This might be subclassified as allergic (e.g., mediated Copyright 2008 Crohn’s & Colitis Foundation reaction. In addition, skin prick testing nonallergic. Allergic anaphylaxis medi- for infliximab has not been validated for Published online 9 December 2008 in Wiley InterScience (www.interscience.wiley.com).
IgE-mediated anaphylaxis.5 It is worth Inflamm Bowel Dis ● Volume 15, Number 9, September 2009 Inflamm Bowel Dis ● Volume 15, Number 9, September 2009 summation anaphylaxis.8 Anaphylaxis 2. Lequerre T, Vittecoq O, Klemmer N, et al.
Management of infusion reactions to infliximabin patients with rheumatoid arthritis or spondy- loarthritis: experience from an immunotherapy unit of rheumatology. J Rheumatol. 2006;33: 3. Cheifetz A, Smedley M, Martin S, et al. The incidence and management of infusion reac- tions to infliximab: a large center experience.
important, as fatalities can occur.7 Ana- Am J Gastroenterol. 2003;98:1315–1324.
phylaxis to infliximab is not ruled out by 4. Pichler WJ. Adverse side-effects to biological Arun Gupta, MB, BS*
agents. Allergy. 2006;61:912–920.
a negative skin prick test, or by a nega- Gary Unglik, MB, BS†
5. Johansson SG, Bieber T, Dahl R, et al. Revised nomenclature for allergy for global use: report Finlay A. Macrae, MB, BS, MD*
tivity of this test for anaphylaxis is low.
of the Nomenclature Review Committee of the World Allergy Organization, October 2003. J Allergy Clin Immunol. 2004;113:832– 836.
perimental and as such not validated.
RL, et al. Second symposium on the definitionand management of anaphylaxis: summary re- port—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphy- laxis Network symposium. J Allergy Clin Im- 7. Pumphrey. Lessons for management of ana- phylaxis from a study of fatal reactions. Clin REFERENCES
Exp Allergy. 2000;30:1144 –1150.
1. Youdim A, Vasiliauskas EA, Targan SR, et al.
8. Ring J, Brockow K, Behrendt H. History and A pilot study of adalimumab in infliximab- classification of anaphylaxis. Novartis Found allergic patients. Inflamm Bowel Dis. 2004;10: Symp. 2004;257:6 –16; discussion 24, 45–50,

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