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Tocilizumab‑induced anaphylaxis in two patients with COVID‐19‐induced cytokine storm

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a zoonotic virus which was first discovered in Wuhan, the People’s Republic of China in December 2019 and has led to one of the greatest pandemics of world history in a short period of time. SARS-CoV-2 is a rapidly spreading infectious disease with a high mortality rate. The disease has a moderate and severe course in approximately 20% of the patients and mortality reaches up to 62% among these patients . The majority of the patients develop SARS-CoV-2-induced pneumonia and manifestations of pneumonia rapidly progress to respiratory failure. The treatment of COVID‐19‐induced cytokine storm is not definitive, several pharmacological agents have been tried and used. Tocilizumab (TCZ) is a promising agent that is used for the treatment of cytokine storm. TCZ is an IgG1 class recombinant humanized monoclonal antibody against interleukin-6 (IL-6) receptor [4].However, potential IgE-mediated immunological reactions against this drug, especially anaphylaxis, may deprive these patients of an important treatment option for the treatment of COVID-19-induced cytokine storm. Although TCZ-induced anaphylaxis has been reported in the literature as case reports of indicated rheumatic diseases, TCZ-induced anaphylaxis has not yet been reported in patients using TCZ for PCR positive COVID‐19‐induced cytokine storms. In this case series, we aimed to represent cases of anaphylaxis which developed in two different patients using TCZ for COVID-19-induced cytokine storm.