Risk factors for fatal and nonfatal reactions to subcutaneous immunotherapy

Epstein, Tolly; Liss, Gary M.; Murphy-Berendts, Karen; Bernstein, David I.

doi:10.1016/j.anai.2016.02.001

Cited by 110 publications

(60 citation statements)

References 22 publications

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“…The rate of systemic reactions is increased with accelerated cluster build-up regimens [3,15,16]. Due to the persistent concern regarding serious or fatal systemic reactions, a North American surveillance project was initiated to annually survey fatal SCIT reactions among certified allergists and data for the years 2008–2013 have been reported [17 ▪ ]. During this period, two direct reports of fatal reactions were confirmed in patients treated by allergists, and two indirectly reported events occurred under the care of nonallergists.…”

Section: Subcutaneous Allergen Immunotherapymentioning

confidence: 99%

“…A recent report from the national surveillance study [17 ▪ ] has identified characteristics of systemic reactions associated with SCIT. During years 4 and 5, the annual survey project has utilized the five-level grading system developed by the World Allergy Organization (WAO) to assess the severity of reported systemic reactions with Grade 1 representing mild reactions and Grade 5 designated as a fatal event [20].…”

Section: Subcutaneous Allergen Immunotherapymentioning

confidence: 99%

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Allergen immunotherapy: an updated review of safety

James

Bernstein

2017

Current Opinion in Allergy &Amp; Clinical Immunology

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124

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Purpose of review Allergen immunotherapy is the only modality that can modify the immune response upon exposure to aeroallergens and venom allergens. This review will update the allergist on recent studies evaluating safety of sublingual and subcutaneous allergen immunotherapy. Recent findings Multiple clinical trials and retrospective studies have been published evaluating overall safety of these therapies. The risk of systemic reactions with subcutaneous immunotherapy remains quite low, but near-fatal and fatal anaphylaxis does occur, requiring physicians to be aware of potential risks for such events. Sublingual immunotherapy has a high incidence of local site application reactions, but severe anaphylactic events are very uncommon. Summary Subcutaneous immunotherapy and sublingual immunotherapy are beneficial in treating allergic rhinitis and venom hypersensitivity but should be administered only by physicians familiar with potential risk factors and able to manage treatment-related local and systemic allergic reactions.

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Section: Subcutaneous Allergen Immunotherapymentioning

confidence: 99%

Section: Subcutaneous Allergen Immunotherapymentioning

confidence: 99%

Allergen immunotherapy: an updated review of safety

James

Bernstein

2017

Current Opinion in Allergy &Amp; Clinical Immunology

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124

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“…Anyhow, sublingual immunotherapy (SLIT) is now a consolidated and safe practice, with proved efficacy as demonstrated by several trials [9–11]. Besides, SLIT presents a very good profile of safety with only an average of 11 anaphylaxis in 1 billion of SLIT doses since 2000 [12]. …”

Section: Introductionmentioning

confidence: 99%

Preventive actions of allergen immunotherapy: the facts and the effects in search of evidence

Martignago

Incorvaia²,

Ridolo

2017

Clin Mol Allergy

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Allergen immunotherapy (AIT) is the only treatment that works on the causes of allergy. Available AIT nowadays are subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) for allergic rhinitis and asthma, while for allergy to Hymenoptera venom only subcutaneous route is recommended. A bulk of trials and meta-analyses demonstrated that efficacy and safety of AIT in decreasing allergic clinical symptoms and use of rescue medications, while its preventive capacity is yet under investigation. The most important of these effects is the prevention of potentially fatal anaphylactic reactions to Hymenoptera stings by venom immunotherapy (VIT). A certain number of studies thus far available showed that AIT, in both forms, is able to prevent the progress of allergic rhinitis into asthma and the development of new sensitizations. These effects should be related to the mechanisms of action of AIT. In fact, it has been demonstrated that both SCIT and SLIT are able to modify the allergen presentation by dendritic cells, with result in modification of the phenotype of allergen-specific T cells, switching from the typical of allergic inflammation Th2-type response to a Th1-type one. Also allergen-specific T regulatory (Treg) cells play a pivotal role by producing suppressive cytokines, such as IL-10 and TGF-beta. However, the only plain evidence of a preventive effect concerns VIT, while the other outcomes need to be furtherly investigated.

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“…El desarrollo de reacciones anafilácti-cas graves durante la realización de pruebas cutáneas con alérgenos o la administración de ITA es poco frecuente 6,7 . La tasa de reacciones sistémicas que requieren la utilización de adrenalina se ha calculado en dos por cada 10.000 series de pruebas cutáneas 8 , y en 1,9% de los pacientes en tratamiento con ITA subcutánea, con una tasa de muerte relacionada con estos tratamientos de 1 por cada 7,22 millones de dosis, según la Academia Americana de Alergología 7 .…”

Section: Discussionunclassified

“…La tasa de reacciones sistémicas que requieren la utilización de adrenalina se ha calculado en dos por cada 10.000 series de pruebas cutáneas 8 , y en 1,9% de los pacientes en tratamiento con ITA subcutánea, con una tasa de muerte relacionada con estos tratamientos de 1 por cada 7,22 millones de dosis, según la Academia Americana de Alergología 7 . En cuanto a ITA con venenos, en un meta-análisis realizado en 2016 no se detectaron muertes en ninguno de los artículos incluidos 9 .…”

Section: Discussionunclassified