AAAAI/ACAAI Surveillance Study of Subcutaneous Immunotherapy (SCIT) injections (Year 2): Time of Onset and Treatment of Systemic Reactions (SRs)

Sublingual immunotherapy (SLIT) currently represents, as indicated by meta-analysis of its efficacy and safety, a valid option to the generally used traditional subcutaneous immunotherapy (SCIT) for treating respiratory allergy. Regarding efficacy, recent studies demonstrated that, similar to what has already been observed in SCIT as well as in experimental and clinical studies about the magnitudo of allergen exposure, the effectiveness on both clinical symptoms and immunologic changes depends on the amount of allergen administered during treatment. In addition, in vitro studies addressed with the role of dendritic cells, currently considered to be of pivotal importance in orienting toward tolerance the immune response to allergens, showed that the internalisation of allergen molecules, which is followed by tolerogenic presentation to T cells, depends on the amount of allergen. However, such dose dependence is not apparent concerning the safety. In fact, the comparison of studies respectively conducted with high and low allergen doses did not show differences in the rate of systemic reactions, which in any case never had the presentation of anaphylaxis, and instead a significant difference in the rate of local reactions, following the oral and gastrointestinal contact with the allergen extract, in favour of high dose studies.

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

10.21203/rs.3.rs-34755/v4 ◽

2020 ◽

Author(s):

Kara Robertson ◽

Nazanin Montazeri ◽

Urvashi Shelke ◽

Samira Jeimy ◽

Harold Kim

Keyword(s):

Incidence Rate ◽

Best Practice ◽

Systemic Reaction ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Subcutaneous Immunotherapy ◽

Single Centre ◽

Epinephrine Administration ◽

Epinephrine Injection ◽

Systemic Reactions

Abstract BackgroundSubcutaneous 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. MethodsA 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.Results28 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.ConclusionsThis 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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Rate of Systemic Reactions to Standardized Allergen Subcutaneous Immunotherapy in Pediatric Patients

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2012.12.1329 ◽

2013 ◽

Vol 131 (2) ◽

pp. AB186

Author(s):

Elena Crestani ◽

Tatyana Sare ◽

Rocco Anzaldi ◽

Al Patterson ◽

Lynda C. Schneider ◽

...

Keyword(s):

Pediatric Patients ◽

Subcutaneous Immunotherapy ◽

Systemic Reactions

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Frequency And Potential Risks Factors For Systemic Reactions (SRs) During Subcutaneous Immunotherapy (SCIT) In A Puerto Rican Cohort.

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2018.12.875 ◽

2019 ◽

Vol 143 (2) ◽

pp. AB286

Author(s):

Yanira Arce-Ayala ◽

Giannina Coppola Fasick ◽

Jorge J. Cruz-Cruz ◽

Sylvette Nazario ◽

Cristina J. Ramos-Romey

Keyword(s):

Puerto Rican ◽

Subcutaneous Immunotherapy ◽

Systemic Reactions ◽

Potential Risks ◽

Risks Factors

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A single centre retrospective study of systemic reactions to subcutaneous immunotherapy

Allergy Asthma & Clinical Immunology ◽

10.1186/s13223-020-00491-5 ◽

2020 ◽

Vol 16 (1) ◽

Author(s):

Kara Robertson ◽

Nazanin Montazeri ◽

Urvashi Shelke ◽

Samira Jeimy ◽

Harold Kim

Keyword(s):

Incidence Rate ◽

Best Practice ◽

Systemic Reaction ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Subcutaneous Immunotherapy ◽

Single Centre ◽

Epinephrine Administration ◽

Epinephrine Injection ◽

Systemic Reactions

Abstract 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.

Download Full-text