title: Hypersensitivity reaction against influenza vaccine in a patient with rheumatoid arthritis after the initiation of etanercept injections.
abstract: A 58-year-old Japanese woman with rheumatoid arthritis (RA) suffered from high fever triggered by administration of an influenza vaccine after a 4-month-long effective treatment course with the TNF-alpha inhibitor etanercept. Influenza vaccine had been previously administrated safely to the patient before initiation of etanercept therapy. The fever occurred without other symptoms soon after vaccine administration, progressed to high fever 1 day later, and spontaneously resolved the second day. The clinical course appears to be compatible with drug fever closely associated with immediate hypersensitivity (in particular, late-phase type I allergic reaction), in which T helper (Th) 2 cells play a crucial role. Etanercept can strongly suppress Th1-mediated reactions; therefore, Th2 activity may be augmented by etanercept treatment in aspect of antagonism between Th1 and Th2 mechanisms. In RA patients who receive treatment with TNF-alpha inhibitor such as etanercept, activation of Th2-mediated immune responses such as immediate hypersensitivity may be a necessary side effect for those who receive vaccinations.
authors.affiliation: Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan. kintarou@s9.dion.ne.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Kato
authors.forename: Akiko
authors.initials: A
authors.lastname: Kiire
authors.forename: Hazime
authors.initials: H
authors.lastname: Yamagata
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yamanaka
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kamatani
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D004342:Drug Hypersensitivity / Q000209:etiology*; D000068800:Etanercept; D005260:Female; D005334:Fever / Q000139:chemically induced; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000139:chemically induced*; D007074:Immunoglobulin G / Q000009:adverse effects*; D007252:Influenza Vaccines / Q000009:adverse effects*; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007252:Influenza Vaccines; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept