Table 2.

Systemic reactions to product switch

SC or IV administration switch	Description of the systemic reaction	Was the patient admitted to hospital?	Was treatment given as an outpatient?	Outcome
SC–SC	Joint and neck pain, headache and stomach ache after infusions (lasting 1–24 hours)	No	No	Switched to alternative product, no further symptoms
SC–SC	Subjective ‘swimming in head’ dizzy and fatigue after infusions (lasting up to 7 days after infusions). No objective symptom on observed infusion but patient described symptoms as being reproducible	No	No	Switched to alternative product, no further symptoms
SC–SC	Headache, malaise, abdominal pain. Painful skin rash	No	Paracetamol, antihistamines, prednisolone (3 days)	Switched back to previous product
SC–SC	Palpitations during infusion. Subsequent (2 weeks later) widespread raised rash	No	Cetirizine	Switched to alternative and rash resolved
IV–IV	Fever, headache, flu-like illness self-described shaking: commenced evening of infusion lasted 1–2 days	No	No	Switched to alternative IV product
IV–IV	Onset of severe back pain 1 hour after leaving clinic.	No	Analgesia	Switched to alternative IV product
	Attended emergency department, treated with pain relief and discharged.
	Fatigue and on-going back pain continued for ‘a couple of days’
IV–IV	Long standing history of intolerances of a number of products.	No	No	Switched back to original product
	Patient reported tiredness on the day after the infusion with joint and muscle pains

IV = intravenous; SC = subcutaneous.