Local reactions during allergen immunotherapy do not require dose adjustment

Tankersley, Michael S.; Butler, Kathryn K.; Butler, William K.; Goetz, David W.

doi:10.1067/mai.2000.110468

Cited by 80 publications

(53 citation statements)

References 3 publications

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“…Our rate of local reaction of 8.3% is a little higher compared to other studies, where the local reaction rate was up to 7% [19, 20, 21]. However, our patients did not need specific treatment for the local reaction and it resolved spontaneously.…”

Section: Discussionmentioning

confidence: 41%

Safety of Subcutaneous Specific Immunotherapy with Pollen Allergen Extracts for Respiratory Allergy

Arifhodžić

Behbehani

Duwaisan

et al. 2003

Int Arch Allergy Immunol

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Background: Specific immunotherapy (SIT) is a well-documented treatment for respiratory allergy. However, the major risk of SIT is the development of systemic anaphylactic reactions. Objectives: To evaluate the safety of SIT given by subcutaneous route for 3 years to patients with seasonal allergic rhinitis (AR) with or without asthma. Methods: A prospective open-label study of immunotherapy (Chenopodium album, Bermuda grass, or both) in 181 consecutive patients with AR with or without asthma. After an initial dose-escalation phase, a maintenance dose of 0.5 ml of 100,000 PNU/ml was administered monthly for 3 years. The occurrence and severity of systemic reaction (SR) and local reaction was recorded and graded according to the WHO position paper. Results: Of 181 patients enrolled, 57 (31%) did not complete the study (53 due to poor compliance and 4 due to systemic side effects). All 4 patients who developed SR had asthma and all the SR occurred during the dose- escalation phase. Three patients had moderate SR (grade 2), while 1 patient had severe reaction (grade 3). Three of the SR occurred within the first 20 min after injection and 1 SR occurred 2 h after injection. None of the reactions were life threatening and were managed easily. Total rhinitis symptom score decreased from 11.8 at baseline to 7.46 at the end of treatment (p < 0.001). The size of the skin prick test reaction to the main sensitising allergen was reduced from 7.48 ± 2.26 mm at baseline to 5.60 ± 2.18 mm at the end of treatment, p < 001. Conclusion: If a strict protocol is used, SIT is safe in AR patients with or without mild asthma and may result in significant subjective and objective improvement.

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Section: Discussionmentioning

confidence: 41%

Safety of Subcutaneous Specific Immunotherapy with Pollen Allergen Extracts for Respiratory Allergy

Arifhodžić

Behbehani

Duwaisan

et al. 2003

Int Arch Allergy Immunol

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“…Not only were dose adjustments not necessary, but concern began to be raised that they actually might serve the opposite purpose and introduce additional visits and injections that then might increase the risk of administration errors and decrease patient compliance due to the additional visits and difficulty achieving maintenance [15]. In 2000, the first paper to evaluate local and systemic reaction rates during periods of both dose adjustment and no dose adjustment for LRs demonstrated no difference in systemic reaction rates (0.8% vs 1.1%), LR rates in systemic patients (7.3% vs 4.7%), or LR rates preceding systemic reactions (18.8% vs 10.5%) [16]. During an 18-month period under the 9-month dose adjustment protocol and then subsequent 9-month no dose adjustment protocol for LRs, the sensitivity of an LR for a systemic reaction was 15%, and the positive predictive value of an LR for a systemic reaction was only 17%.…”

Section: Current Local Reaction Literature and Recommendationsmentioning

confidence: 93%

How Should Allergists Deal With Local Reactions to Allergen Immunotherapy?

Tankersley

2010

Curr Allergy Asthma Rep

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Despite the well-known benefits of subcutaneous immunotherapy (SCIT), adverse reactions include both local reactions (LRs) and systemic reactions. An LR is a well-known adverse event associated with SCIT injections and is defined as any swelling located at or near the injection site following allergen injection. Concerns that LRs might predict systemic reactions have historically motivated allergists to dose adjust for LRs. More recent data have dispelled this notion, although many allergists continue to dose adjust for other reasons. This article discusses the historical response to LRs and dose adjustments and reviews the most recent literature addressing LRs to SCIT. Treatment options, although they are either unproven or not studied, are offered as an alternative to routine dose adjustments for LRs. Education remains the foundation of physician-patient communication concerning LRs.

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“…However, systemic anaphylactic reactions are unavoidable and for this reason the attending physician must take all measures necessary to deal with such incidents (15). The most frequent side effects of immunotherapy are the anaphylactic reaction, the asthma attack, the urticaria, the larynx edema and the angioedema (18)(19)(20)(21). The side effects are usually observed during the first 30-min after the injection of allergen and rarely hours later (18,21).…”

Section: Discussionmentioning

confidence: 99%

The Safety of Immunotherapy in Patients with Allergic Asthma and Allergic Rhinitis

Ilonidis¹,

Anogianakis

Theofilogiannakos

et al. 2005

Eur J Inflamm

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We studied systemic reactions associated with immunotherapy in a group of 50 patients with mean age 31.4 years. The group consisted of36 women and 14 men who followed a three-year immunotherapy treatment with pollen and mite allergen extracts (HAL-Holland Corporation). A total number of 2550 injections were administered. Eight patients developed systemic reactions; 6 had allergic rhinitis and 2 allergic asthma. None developed severe anaphylaxis. Seven of the systemic reactions occurred immediately after injection while one was a late reaction manifested as generalized urticaria, local edema and rubor at the site of the injection. From the 7 patients who showed an immediate reaction, 5 developed generalized urticaria with local edema and rubor at the site of the injection, while 2 presented with bronchial spasm. We did not observe any reaction when the quantity of the extract injection was reduced by 50%. Our study points out that, in the vast majority of cases, immunotherapy is free of severe systemic reactions. Those that occur are associated with the injection of high-density extracts and none of them is severe.Allergen immunotherapy is an effective treatment modality for Hymenoptera hypersensitivity, allergic rhinitis and asthma (1-2). Some researchers question or, even, reject the effectiveness of this therapy in asthma, while others claim that it is effective only in specific circumstances(3-6). Immunotherapy was first applied in 1911 by Noon to treat seasonal rhinitis (7). Soon it was evident that treatment was often accompanied by allergic reactions. Since then, research is focused on increasing the effectiveness of immunotherapy while minimizing its side effects: New types of extracts are used to better control systemic allergic reactions; immunotherapy is applied to low-risk individuals only (e.g., individuals without systemic disease, with good cardiopulmonary function and not on medication) and substantial measures are taken in order to reduce the number and the severity of symptoms (8-9). The majority of reactions to immunotherapy are mild and fatal reactions are extremely rare (9-10). This becomes particularly evident when the high frequency of extract injections during immunotherapy is taken into consideration (10). According to the International Consensus Report on Diagnosis and Management of Asthma, immunotherapy is recommended when the patient cannot avoid allergens or when the suitable drug treatment, fails to control the symptoms of asthma (11). MATERIALS AND METHODSWe studied 50 patients who followed a three-year long immunotherapy treatment with extracts of aller-

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Local reactions during allergen immunotherapy do not require dose adjustment

Cited by 80 publications

References 3 publications

Safety of Subcutaneous Specific Immunotherapy with Pollen Allergen Extracts for Respiratory Allergy

Safety of Subcutaneous Specific Immunotherapy with Pollen Allergen Extracts for Respiratory Allergy

How Should Allergists Deal With Local Reactions to Allergen Immunotherapy?

The Safety of Immunotherapy in Patients with Allergic Asthma and Allergic Rhinitis

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