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Don't Take Drug X if you are allergic to Drug X

If you listen to the commercials for the DMARDs (Disease Modifying AntiRheumatic Drugs) which basically work by blocking specific cytokines, they all say in the fine print talking about safety (in addition to cancer and serious infection, etc) , wording like Don't take Drug X if you are allergic to Drug X or any of its ingredients. I think that is the exact wording for Humira, but Cosentyx, Tremfya, Sotyktu, Xeljanz, Skyrizi, Stelara, all say similar wording. At first look I find it funny the thought: a person just doesn't suddenly wake up one day and say if they have never taken a drug: "Say, I think I may be allergic to Drug X or this specific ingredient, so I won't take it" which the wording sounds that is what happening. This is wording created by lawyers: what it really means: " if you have taken Drug X and you have had a serious reaction to it, Do not take it again"

This is the same thing with GBCAs... If you developed a serious reaction to it- that is GDD- then don't ever take it again. This is my principle message and principle direction. If a person develops GDD after one lifetime injection fo GBCA a sizable number will recover on their own with no specific treatment. One major difference/ problem with GBCA is that a certain fraction of the agent, probably something like 1% stays with you more or less permanently, unless you specifically get it removed. So the agent that is giving you a major reaction is staying with you - that is the exposure has persistence and is not transient. It does make one wonder how many of everything else we take has persistence and is not transient?

It also seems absurd if one thinks about it- you are getting some chemical which is not native to your body... why is it not perfectly reasonable that some people will have an allergic reaction to it (in this case a Tcell dysregulation [type of allergy]). If people can be allergic to essentially any foreign chemical/ antigen - then why not a small molecule with a toxic heavy metal in it - wrapped up like like an anti- pig-in-a- blanket (the tasty unhealthy food item). Ofcourse they can. I still am set on the numbers I have written: 1 in 10,000 get mild disease from 1 injection and 1 in 100,000 can get very serious disease. This same concept ofcourse is true with acute hypersensitivity reaction to GBCA and NSF. an aside I did not know that there were so many people with psoriasis, that a number of companies make anti-psoriasis drugs and still all make a lot of money ... There are so many commercials for these drugs, because a number of them make 1 billion $ per year.

I have been hopeful and remain hopeful that one DMARD will be useful for severe cases of GDD, and I suspect the same drug may have good effect with COVID vaccine Long HAUl and possibly COVID Long Haul. GDD the poor orphan step-child of these other Tcell dysregulations may have to wait to see, with the billions invested in COVID research, that a DMARD will be created for them, which I believe would be also helpful with GDD.

First rule with GDD: Don't Take GBCA if you are allergic to GBCA

Richard Semelka, MD


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