Managementul reacţiilor de hipersensibilitate întârziată (RHI) la interferonul alfa (IFN α)

Interferons α (2a and 2b) are glycoproteins whose main indications are the treatment of chronic hepatitis C and melanoma. IFNs have the potential to induce a particular subset of adverse reaction due to their structural resemblance, but also their differences to the endogenous IFN α. IFN α (2a and 2b) can cause localized (injection site) or generalized cutaneous reactions, which represent about 5-12% of the total adverse reactions to this class. So far, the exact pathogenesis of the hypersensitivity reactions (HSR) to IFN α remains largely unknown, although several authors have tried to explain and demonstrate the mechanisms of these reactions, with more or less success. The management of HSR is guided mostly by the evaluation of the initial clinical severity, thus the treatment with INF α can be either permanently stopped, in case of a severe reaction, or continued in case of a mild reaction, especially if the medication is essential and a standardized desensitization protocol is available.  Purpose of the paper. To perform a review of the literature regarding HSR to IFN α, an area where literature data are scarce. The paper proposes to focus on delayed hypersensitivity reactions (DHR) to IFN α and their management.  Materials and method. Theoretical notions including expert´s opinion on DHR, their management and recommendation for desensitization will be discussed.  Results. The theoretical part will by illustrated by the means of a case presentation.  Conclusions. The clinical decision for the management of DHR to IFN α is based on multiple factors, such as the type of reactions, its severity, and patient-dependent factors such as the disease to be treated with IFN α. Choosing a solution can sometimes prove to be a very difficult task, especially if standardized, reliable desensitization protocols for the culprit drug are not available.