IP International Journal of Orthopaedic Rheumatology 2021;7(2):90–92 Content available at: https://www.ipinnovative.com/open-access-journals IP International Journal of Orthopaedic Rheumatology Journal homepage: www.ijor.org Case Report Patient on allergen immunotherapy developed systemic lupus erythematosus?– A clinico-pharmacological look out Shambo S Samajdar 1 , Shatavisa Mukherjee 1, *, Kaushik Basu 2 , Saibal Moitra 3 , Santanu K Tripath 4 1 Dept. of Clinical & Experimental Pharmacology, School of Tropical Medicine, Kolkata, West Bengal, India 2 Dept. of General Medicine, Medical College & Hospital, Kolkata, West Bengal, India 3 Dept. of Allergy & Immunology, Apollo Gleneagles Hospital, Kolkata, West Bengal, India 4 Dept. of Pharmacology, Netaji Subhash Medical College & Hospital, Patna, Bihar, India ARTICLE INFO Article history: Received 06-12-2021 Accepted 17-12-2021 Available online 12-01-2022 Keywords: Allergen Immunotherapy Systemic Lupus Erythematosus Drug induced lupus Clinico pharmacological evaluation ABSTRACT Drug induced lupus is an autoimmune condition secondary to drug exposure which leads to development of systemic lupus erythematosus (SLE). However, labelling the culprit drug needs a prudent insight into the pharmacological plausibility of each of the offending drugs in suspicion. Here we present a report where allergen immunotherapy was suspected to cause SLE and a deeper clinico-pharmacological evaluation cleared the air. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. For reprints contact: reprint@ipinnovative.com 1. Introduction Allergen Immunotherapy (AIT) has seen widespread advancements in the arena of atopic diseases over the past decades. However, its use has been linked and has regarded contraindicated in patients with rheumatologic complications. Evidence to support the idea that AIT can trigger autoimmune disease is considerably weak and is mainly based on few case reports highlighting causation of vasculitis. 1 However, no report of patients developing autoimmune diseases has been reported from randomised controlled trials probing the effect of AIT. Even, there exist pharmaco-epidemiological studies which have failed to detect any increased risk of autoimmune disease development during AIT compared with other conventional allergy procedures. Nevertheless, due to lack of available data, researchers propose there is relative contraindication in autoimmune * Corresponding author. E-mail address: shatavisa100@gmail.com (S. Mukherjee). disorders in remission and absolute contraindications in active forms with AIT. As a principle of caution, it is prudent to undergo a detailed risk-benefit assessment in auto-immune disease candidates in need of AIT. A detailed clinical examination of the patient status along with careful consideration of all related factors may show up the flip side of the story. Here we present a similar instance of clinical dilemma in a 24-year-old male. 2. Case Report MK, 24 year old male, patient initially presented with moderate to severe persistent allergic rhinitis for 1 year and asthma for 2 years on step 3 management strategy. His initial laboratory work-up demonstrated eosinophilia (14%) in peripheral blood smear with total leucocyte count (7800/uL), elevated IgE total (2045 IU/ml), high FeNO (78 ppb). Skin prick test report suggested hypersensitivity with dust mites, pollens like Cocos nucifera, Azadirachta indica and Cynodon dactylon. He had also skin prick test positivity with foods like milk, wheat, cauliflower, prawn, https://doi.org/10.18231/j.ijor.2021.020 2581-8112/© 2021 Innovative Publication, All rights reserved. 90