The relationship between drug induced immunogenicity and hypersensitivity reactions and skin tests related to infliximab, etanercept and adalimumab in patients with rheumatoid arthritis and ankylosing spondylitis

Abstract

Background and aim: We aimed to investigate the relationship between serum anti-drug antibody (ADAb), hypersensitivity reactions (HSRs) to anti-tumor necrosis factors (anti-TNFs) drugs and to detect the role of skin tests in the diagnosis of HSRs against anti-TNFs.Material and methods: 69 ankylosing spondilitis (AS) and 46 rheumatoid artritis (RA) patients using infliximab, adalimumab, and etanercept were enrolled. Disease activity scores for AS and RA patients were assessed. Serum levels of anti-TNFs and ADAb to these agents were measured with the ELISA.These blood samples were taken 24 hours before the next drug dose.The patients with anti-TNF-associated HSRs were evaluated with a skin prick test (SPT) and intradermal test (IDT). Readings for SPT and IDT were conducted after 15 min, 24, 48, and 72 hours. Heel diameter of 3 mm or more, greater than negative control was considered positive for SPT, and if the size of the initial wheal had increased by at least 3 mm in diameter and was surrounded by erythema was considered positive for IDT. Symptoms such as urticaria/angioedema, flushing, etc. were considered immediate type HSRs. Findings developed at the injection site such as swelling, erythema, etc were considered injection site reactions (ISRs). An overall p