Multiple Injection Site Reactions after Treatment with Different Biologics for Psoriasis and Psoriatic Arthritis

Abstract

Psoriasis (PsO) is an autoimmune disease characterized by erythematous, pruritic, and scaly plaques that can be distributed throughout the body. The development of biologic treatments targeting an array of molecular pathways, including tumor necrosis factor-ɑ  or interleukins (IL) 12, 23, 17A, and 17F, has advanced treatment options for these patients. In this article, we report a unique case of a 35-year-old female with 11-year history of PsO and a new onset of guttate PsO following an episode of streptococcal pharyngitis. She was subsequently treated with guselkumab, bimzekizumab, and ixekizumab, developing injection site reactions to each biologic. The patient was suspected to be allergic to polysorbate-80 (PS-80), an aqueous medium to stabilize biologics before administration. Notably, the patient had a negative response to PS-80 on allergy testing, and it remains unclear why the patient experienced ISR with certain medications and not others. Further research is needed to characterize ISR across the different biologics, particularly newer medications being utilized in clinical settings.