title: Selective TNF-α inhibitor-induced injection site reactions.
abstract: BACKGROUND
  During the last decade, many new biological immune modulators entered the market as new therapeutic principles. TNF-α is a pro-inflammatory cytokine known to a have a key role in the pathogenic mechanisms of various immune-mediated or inflammatory diseases. TNF-α blockers have demonstrated efficacy in large, randomized controlled clinical trials either as monotherapy or in combination with other anti-inflammatory or disease-modifying anti-rheumatic drugs.
  
  
  METHODS
  Although generally well tolerated and safe, potential adverse events may be associated with TNF-α inhibitor treatment. The authors will briefly review the potential adverse drug reactions and the immunological mechanisms of injection site reactions (ISRs) in patients treated with etanercept and adalimumab.
  
  
  CONCLUSIONS
  Patients treated with TNF-α inhibitors can develop ISR around the sites of injections. 'Type IV delayed type reaction' or 'recall ISRs'. Eosinophilic cellulitis or 'Wells syndrome', 'type III' and 'type I' reactions are reported. Long-term studies are necessary to determine the durability of response and the real risk of ISRs with golimumab and certolizumab pegol. Further studies are also necessary to evaluate the immunogenicity of these drugs.
authors: University of Genova, Department of Internal Medicine, Clinical Immunology Unit, Viale Benedetto XV, n. 6, 16132 Genova, Italy. Giuseppe.Murdaca@unige.it
authors: Giuseppe
authors: G
authors: Murdaca
authors: Francesca
authors: F
authors: Spanò
authors: Francesco
authors: F
authors: Puppo
mesh_terms: D000068879:Adalimumab; D000818:Animals; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003877:Dermatitis, Contact / Q000276:immunology / Q000378:metabolism; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage / Q000009:adverse effects; D007249:Inflammation / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology; D018836:Inflammation Mediators / Q000008:administration & dosage / Q000009:adverse effects; D055104:Infusions, Subcutaneous / Q000009:adverse effects; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000378:metabolism
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018836:Inflammation Mediators; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D000068800:Etanercept