RESEARCH - Hypersensitivity reaction against influenza vaccine in a patient with RA after the initiation of Enbrel injections

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Mod Rheumatol. 2006;16(5):327-9.

Hypersensitivity reaction against influenza vaccine in a patient with

rheumatoid arthritis after the initiation of etanercept injections.

Kato T, Kiire A, Yamagata H, Yamanaka H, Kamatani N.

Institute of Rheumatology, Tokyo Women's Medical University, 10-22

Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan. kintarou@...

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.

PMID: 17039318

http://www.ncbi.nlm.nih.gov/pubmed/17039318?ordinalpos=9 & itool=EntrezSystem2

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