Hypersensitivity reactions
Anakinra causes ADRs in 75% of patients. Many of them are related to injection site reactions within the first weeks of application and can present either as an IHR or NIHR (144,145). Systemic IHRs such as urticaria, angioedema, anaphylaxis (146-148), and NIHRs (149) as infiltrating erythematous skin plaques were rarely reported as single cases. IHR after a first dose of anakinra was reported in a case possibly due to components that are able to induce a direct mast cell degranulation (148,150).
For evaluating IHRs to anakinra, SPTs, and IDTs were performed with the undiluted drug (147,148). Both for IHRs (146,148) and NIHRs (149), successful desensitization protocols were reported.