title: Anaphylaxis to anakinra in a pediatric patient with systemic juvenile idiopathic arthritis successfully treated with canakinumab: a case-based review.
abstract: We present the case of a 2-year-old boy with a history of necrotizing enterocolitis (NEC) with ileostomy diagnosed with systemic juvenile idiopathic arthritis (sJIA) at 10 months of age controlled on anti-interleukin-1 (anti-IL-1) therapy (anakinra). At 17 months of age, ileostomy reversal and bowel re-anastomosis was scheduled with anakinra discontinued 3 days prior to the surgery and steroids initiated in its place. Ten days postoperatively, anakinra was re-started for signs of sJIA flare. Three months later, he developed persistent peripheral eosinophilia and subsequent anaphylactic reaction 6 months postoperatively. The patient safely tolerated an alternative anti-IL-1 agent (canakinumab). Anaphylaxis to anakinra has not been previously reported in the pediatric literature. This case highlights an important issue in a pediatric patient with sJIA: safety of an alternate anti-IL-1 agent, following development of allergy to one initial agent.
authors.affiliation: Department of Pediatric Rheumatology, Hospital for Special Surgery; New York-Presbyterian Hospital/Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA. CAguiar66@hotmail.com.
authors.forename: Cassyanne L
authors.initials: CL
authors.lastname: Aguiar
authors.affiliation: Department of Pediatric Rheumatology, Hospital for Special Surgery; New York-Presbyterian Hospital/Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Pan
authors.affiliation: Department of Pediatric Rheumatology, Hospital for Special Surgery; New York-Presbyterian Hospital/Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Alexa
authors.initials: A
authors.lastname: Adams
authors.affiliation: Department of Pediatric Rheumatology, Hospital for Special Surgery; New York-Presbyterian Hospital/Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA.|Department of Pediatric Rheumatology, Mount Sinai Hospital, New York, NY, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Barinstein
authors.affiliation: Department of Pediatric Rheumatology, Hospital for Special Surgery; New York-Presbyterian Hospital/Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Lehman
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced*; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001171:Arthritis, Juvenile / Q000150:complications* / Q000188:drug therapy*; D002675:Child, Preschool; D004802:Eosinophilia / Q000209:etiology; D006801:Humans; D007081:Ileostomy; D053590:Interleukin 1 Receptor Antagonist Protein / Q000009:adverse effects*; D053583:Interleukin-1beta / Q000037:antagonists & inhibitors; D008297:Male; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D053590:Interleukin 1 Receptor Antagonist Protein; D053583:Interleukin-1beta; D013256:Steroids; C541220:canakinumab
keywords: Anakinra; Anaphylaxis; Anti-interleukin-1; Canakinumab; Interleukin-1 receptor antagonist; Systemic juvenile idiopathic arthritis