Systemic Reactions to Immunotherapy

Abstract

Systemic anaphylactic reactions occur in a small percentage of patients receiving allergen immunotherapy. A I year study was performed in a large health maintenance organization to determine the incidence of systemic reactions (SR) to allergen immunotherapy.We measured the number of SR that occurred during a 12 months period. A SR data sheet was completed for each reaction, documenting the time of onset, symptoms, treatment, history of asthma or previous reaction, and concentration and type of extract.Twenty-seven thousand eight hundred six injection visits resulted in 143 SR (0.51%). Forty-five percent of the patients (pts) with SR had a history of prior SR, 50% had a history of asthma, and 36% developed reactions in season. Seventy-two percent of SR started within 30 minutes, although 8% appeared after 2 hours. Fifty-seven percent of SR occurred at concentrations of 1,000-10

Delayed onset and protracted progression of anaphylaxis after omalizumab administration in patients with asthma

“…The most common example is allergen immunotherapy. 12,13 Rare instances of delayed-onset anaphylaxis have been reported for b-lactams 14 and for intramuscular L-asparaginase. 15 More recently, delayed anaphylaxis of as long as 24 hours after drug administration has been reported for several other mAb therapies, including infliximab, 16 trastuzumab, 17 daclizumab, 18 basiliximab, 19 and gemtuzumab ozogamicin.…”

The diagnosis and management of anaphylaxis: An updated practice parameter

“…66,[189][190][191] The rate of systemic reactions to allergen immunotherapy injections is approximately 0.5%. 192 Thus although severe systemic reactions to allergen immunotherapy are uncommon, physicians and patients should be prepared for possible systemic reactions after immunotherapy. 55.…”

“…66,189,190,[192][193][194][195] However, allergic asthma is an important clinical indication for allergen immunotherapy. Caution is advised when administering allergen immunotherapy vaccine if asthma is severe or poorly controlled.…”

Risk and safety of immunotherapy

“…However, it is difficult to estimate the risk and safety of any mode of therapy whose mechanism of action is not fully understood. Many well-designed studies have proven SIT to be safe under appropriate conditions, but controversies over its beneficial or adverse effects persist (1,(5)(6)(7)(8)(9)(10)(11). The safety of SIT could be disputed for two main reasons: 1) during the treatment, systemic reactions, including those life-threatening, may occur 2) SIT, which may be perceived as an immunostimulating treatment, may induce various immunologic alterations which have not been precisely described until now.…”