Successful Rapid Subcutaneous Desensitization to Anakinra in a Case of Delayed-Type Hypersensitivity Reaction

The document reports a successful rapid subcutaneous desensitization protocol for a 24-year-old woman with refractory adult-onset Still disease who developed a delayed-type hypersensitivity reaction to anakinra, a drug used for her condition. The patient initially showed rapid clinical improvement with anakinra treatment but developed severe erythematous skin plaques one month later. Upon discontinuation of anakinra and treatment with topical steroids, her symptoms subsided, but the Still disease symptoms flared up. Attempts to reintroduce anakinra with prednisone and switch to etanercept were unsuccessful. A desensitization protocol was then implemented, involving six to seven consecutive injections of gradually increasing anakinra doses over three days. The patient reached the full target dose of 100 mg by day 3 and maintained this with once-daily injections. After three months, she did not experience further skin reactions, and her Still disease symptoms were fully controlled. This case is the first reported successful rapid desensitization to anakinra for a delayed-type lichenoid reaction, suggesting the potential effectiveness of this procedure for both acute and delayed-type hypersensitivity reactions.