Comparison of Pediatric and Adult Systemic Reactions to Subcutaneous Immunotherapy

Lim, Chen E.; Sison, Cristina; Ponda, Punita

doi:10.1016/j.jaip.2017.01.014

Cited by 19 publications

(18 citation statements)

References 25 publications

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“…In our study, we focused on documenting the patient characteristics and reaction details following the adoption of these guidelines in an attempt to elicit common predisposing risk factors for systemic reactions while on subcutaneous immunotherapy. Our recorded incidence rate for systemic reactions was approximately 0.095% per injection, comparable or below the rate published in similar studies (0.1% to 0.3%) [ 7 – 9 , 18 ]. Our low incidence rate may simply have been skewed by the inclusion criteria used in our retrospective review (administration of intramuscular epinephrine).…”

Section: Discussionsupporting

confidence: 83%

“…Several surveys have reported that the fatality rate is estimated to be approximately 1 in 2.5 million injections. [ 3 – 5 ] Although these fatal reactions are rare, the generally accepted incidence of systemic reactions per injection is between 0.1% and 0.3% [ 6 – 8 ] Furthermore, retrospective and prospective studies of inhalant immunotherapy following conventional schedules have been reported from the United States [ 7 – 9 ] Turkey [ 10 , 11 ], Israel [ 12 ], Portugal [ 13 ], Italy [ 14 , 15 ], and Spain [ 16 ]. However, Canadian data has not yet been published.…”

Section: Introductionmentioning

confidence: 99%

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A single centre retrospective study of systemic reactions to subcutaneous immunotherapy

Robertson

Montazeri

Shelke

et al. 2020

Allergy Asthma Clin Immunol

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Background Subcutaneous immunotherapy (SCIT) is the standard approach for treating patients with sensitizations to aeroallergens. However, immunotherapy can trigger severe systemic reactions if delivered inappropriately or to high risk patients. We sought to characterize and quantify SCIT systemic reactions requiring epinephrine administration during a 6-year period in a Canadian setting following the recommendations for components and dosages published in the 2010 Canadian Society of Allergy and Clinical Immunology (CSACI) Immunotherapy Manual. Methods A single centre retrospective chart review was performed for all patients with systemic reactions to subcutaneous immunotherapy requiring intramuscular epinephrine injection between January 2011 and October 2017. Each systemic reaction requiring epinephrine was reviewed for baseline patient characteristics, details of the reaction, and reaction severity. Research ethics approval was obtained through McMaster University. Results 28 of 380 patients experienced a systemic reaction requiring epinephrine administration, with an incidence rate of 1 per 1,047 injection visits (0.095%). 26 of the 28 reactions occurred within the mandatory 30-minute observation period post allergen immunotherapy. Of the 28 patients that experienced a systemic reaction to SCIT, 11 patients had asthma and 5 patients had a history of possible food allergy. All of the systemic reactions occurred during injections from vial number 4, and five patients reacted to their first shot of a re-ordered extract. 10 of the 28 patients required more than one intramuscular injection of epinephrine, and 20 of 28 patients were transferred to the hospital by ambulance. Conclusions This is the first Canadian study to review patients with systemic reactions to subcutaneous immunotherapy. Several best practice methods were employed throughout the study to optimize subcutaneous delivery of immunotherapy extract, and our recorded per injection incidence rate for systemic reactions was comparable or below the rate published in similar studies. The recommendations in the CSACI Immunotherapy Manual provide an approach to standardizing prescriptions for SCIT to maximize immunotherapy efficacy and reduce the risk of systemic reactions, though similar studies in larger multicenter settings are needed to confirm these observations. These observations provide important objective information to clinicians about the potential risks for systemic reactions in patients considering SCIT.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

A single centre retrospective study of systemic reactions to subcutaneous immunotherapy

Robertson

Montazeri

Shelke

et al. 2020

Allergy Asthma Clin Immunol

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“…Our recorded incidence rate for systemic reactions was approximately 0.095% per injection, comparable or below the rate published in similar studies (0.1% to 0.3%). 7,8,9,18 Our low incidence rate may simply have been skewed by the inclusion criteria used in our retrospective review (administration of intramuscular epinephrine). However, we felt this requirement would be the most de nitive method of con rming a true reaction.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] Although these fatal reactions are rare, the generally accepted incidence of systemic reactions per injection is between 0.1% to 0.3%. [6][7][8] Furthermore, retrospective and prospective studies of inhalant immunotherapy following conventional schedules have been reported from the United States, [7][8][9] Turkey, 10,11 Israel, 12 Portugal, 13 Italy, 14,15 and Spain. 16 However, Canadian data has not yet been published.…”

Section: Introductionmentioning

confidence: 99%

A single-centre retrospective study of systemic reactions to subcutaneous immunotherapy

Robertson¹,

Montazeri

Shelke

et al. 2020

Preprint

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Background Subcutaneous immunotherapy (SCIT) is the standard approach for treating patients with sensitizations to aeroallergens. However, immunotherapy can trigger severe systemic reactions if delivered inappropriately or to high risk patients. We sought to characterize and quantify SCIT systemic reactions requiring epinephrine administration during a 6-year period in a Canadian setting following the recommendations for components and dosages published in the 2010 Canadian Society of Allergy and Clinical Immunology (CSACI) Immunotherapy Manual. Methods A single centre retrospective chart review was performed for all patients with systemic reactions to subcutaneous immunotherapy requiring intramuscular epinephrine injection between January 2011 and October 2017. Each systemic reaction requiring epinephrine was reviewed for baseline patient characteristics, details of the reaction, and reaction severity. Research ethics approval was obtained through McMaster University. Results 28 of 380 patients experienced a systemic reaction requiring epinephrine administration, with an incidence rate of 1 per 1,047 injection visits (0.095%). 26 of the 28 reactions occurred within the mandatory 30-minute observation period post allergen immunotherapy. Of the 28 patients that experienced a systemic reaction to SCIT, 11 patients had asthma and 5 patients had a history of possible food allergy. All of the systemic reactions occurred during injections from vial number 4, and five patients reacted to their first shot of a re-ordered serum. 10 of the 28 patients required more than one intramuscular injection of epinephrine, and 20 of 28 patients were transferred to the hospital by ambulance. Conclusions This is the first Canadian study to review patients with systemic reactions to subcutaneous immunotherapy. Several best practice methods were employed throughout the study to optimize subcutaneous delivery of immunotherapy serum, and our recorded per injection incidence rate for systemic reactions was comparable or below the rate published in similar studies. The recommendations in the CSACI Immunotherapy Manual provide an approach to standardizing prescriptions for SCIT to maximize immunotherapy efficacy and reduce the risk of systemic reactions, though similar studies in larger multicenter settings are needed to confirm these observations. These observations provide important objective information to clinicians about the potential risks for systemic reactions in patients considering SCIT.

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“…♦ Try alternative dosing schedules in children to prevent local and mild systemic reactions [74,75].…”

Section: Research Studies On Improving Ait Adherence: Key Findingsmentioning

confidence: 99%

Allergen Immunotherapy: Efficacy, Persistence, Consistency, and Cost Effectiveness

Wallace

Уоллес²

2018

Vestn. Ross. univ. družby nar., Ser. Med.

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Although allergen immunotherapy (AIT) has been used for the treatment of allergic rhinitis (AR), allergic conjunctivitis, asthma, stinging insect hypersensitivity, and atopic dermatitis for over 100 years, it has been slow to gain universal acceptance. With the publication of the "World Health Organization Position Paper, Allergen Immunotherapy" in 1998 which summarized the scientific evidence for the efficacy and long-term benefit of this therapy, it has become an accepted and respected modality of treatment. In this review there are discussed following topics of allergen immunotherapy: the reasons for recommending AIT, mechanism of action, subcutaneous and sublingual methods of application, duration, adherence and cost effectiveness. It is necessary to support, not blame, the patient for nonadherence as it is the responsibility of the patient, the physician, and the health-care system to create an environment in which the patient can be adherent. Nonadherence is multifactorial in most every patient and the physician must address all of the factors if adherence is to be improved. The greatest challenge is taking the time to create an individualized patient-tailored strategy to improve adherence, as one size does not fit all. Adherence is dynamic and selecting the best time to start AIT and assuring that there is close follow-up through AIT years of treatment is essential. The patient who is persistent and consistent in year one of AIT may not continue to be so in year three without added encouragement and support. The health-care systems and professional organizations need to help train physicians and their staff both in efficient and accurate ways to assess nonadherence and in implementing interventions to optimize adherence. The multidisciplinary approach to treating this disease of nonadherence will require the involvement of all healthcare professionals, researchers, professional organizations, insurance companies, and policy-makers.

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Comparison of Pediatric and Adult Systemic Reactions to Subcutaneous Immunotherapy

Cited by 19 publications

References 25 publications

A single centre retrospective study of systemic reactions to subcutaneous immunotherapy

A single centre retrospective study of systemic reactions to subcutaneous immunotherapy

A single-centre retrospective study of systemic reactions to subcutaneous immunotherapy

Allergen Immunotherapy: Efficacy, Persistence, Consistency, and Cost Effectiveness

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