scholarly journals Adverse Systemic Reaction Rates with Omalizumab, Subcutaneous Immunotherapy, and Combination Therapy in Children with Allergic Asthma

2018 ◽  
Vol 141 (2) ◽  
pp. AB13
Author(s):  
Daniel Har ◽  
Min Jung Lee
Keyword(s):  
Combination Therapy ◽  
Allergic Asthma ◽  
Systemic Reaction ◽  
Reaction Rates ◽  
Subcutaneous Immunotherapy

scholarly journals A 5-year Study of Systemic Reactions Using both Shared and Patient-Specific Vaccines

2013 ◽  
Vol 4 (2) ◽  
pp. ar.2013.4.0057 ◽  
Author(s):  
Julian Melamed ◽  
Ami Mehra ◽  
Angela Ahuja-Malik
Keyword(s):  
Specific Immunotherapy ◽  
Systemic Reaction ◽  
Reaction Rates ◽  
Patient Specific ◽  
Subcutaneous Immunotherapy ◽  
Allergic Reactions ◽  
World Allergy Organization ◽  
Patient Records ◽  
Systemic Reactions ◽  
Dosage Errors

The safety of shared specific vaccines (SSVs) has been questioned by some experts. The purpose of this study was to evaluate the safety of SSVs. Details of systemic allergic reactions after subcutaneous immunotherapy injections were captured on a standardized form from July 2005 to July 2010. Patient records were evaluated for factors that might be associated with increased rate of systemic reactions and, in addition, were examined for any errors. Systemic reaction rates (SRRs) using a combination of shared and patient-specific vaccines (PSVs) were similar to previously reported studies (0.23 reactions per 100 shots). There were no systemic reactions resulting from errors where the incorrect shared allergen was administered, but we did note one reaction after an erroneously administered PSV. There were two dosage errors associated with both shared and patient-specific immunotherapy. Most reactions were mild to moderate (World Allergy Organization grade, 1 or 2). Severe reactions with 911 activations were noted in six patients. Thirty percent of reactions occurred out of the office and the average time to reaction was 48 minutes. Epinephrine was administered in only 60% of patients. Epicutaneous reactivity to mites, cats, dogs, and pollen but not mold occurred significantly more in reactors. Differences in SRRs were encountered between satellite offices. Using a combination of SSV and PSV, SRRs were similar to previously reported studies; moreover, no systemic reactions occurred where a SSV was erroneously administered. SRR surveillance is a useful safety tool.

scholarly journals Allergen-specific subcutaneous immunotherapy in allergic asthma: immunologic mechanisms and improvement

2010 ◽  
Vol 5 (1) ◽  
pp. 5303 ◽  
Author(s):  
YousefA. Taher ◽  
PaulA.J. Henricks ◽  
AntoonJ.M. van Oosterhout
Keyword(s):  
Allergic Asthma ◽  
Subcutaneous Immunotherapy

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

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.

scholarly journals A single centre retrospective study of systemic reactions to subcutaneous immunotherapy

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.

scholarly journals Dropouts From Sublingual Immunotherapy and the Transition to Subcutaneous Immunotherapy in House Dust Mite-Sensitized Allergic Rhinitis Patients

2022 ◽  
Vol 2 ◽  
Author(s):  
Huan Chen ◽  
Guo-qing Gong ◽  
Mei Ding ◽  
Xiang Dong ◽  
Yuan-li Sun ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Allergic Asthma ◽  
House Dust ◽  
House Dust Mite ◽  
Sublingual Immunotherapy ◽  
Dropout Rates ◽  
Subcutaneous Immunotherapy ◽  
Transition Rates ◽  
Dust Mite

Purpose: Both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) are effective in reducing symptoms and medication scores and inducing long-term efficacy in patients with allergic rhinitis (AR). However, SLIT has been associated with poor patient adherence. This study investigates the factors impacting dropout rates from SLIT in house dust mite (HDM)-sensitized AR patients.Methods: A retrospective study was performed to analyze dropout rates and reasons in AR patients receiving Dermatophagoides farinae (Der f) SLIT with a follow-up period of 2 years.Results: A total of 719 HDM-sensitized AR patients received Der f-SLIT. Dropout rates increased with time and most occurred after 1 year of SLIT. By month 24, 654 (91%) patients had discontinued SLIT. The dropout rates by month 24 were 100, 90.1, and 91.1% in children <5 years old, children aged 5–18 years old, and adults ≥ 18 years old, respectively. Combination with allergic asthma and mono- or multi-sensitization to other aeroallergens did not affect the dropout rates. The most common self-reported reasons for dropouts were refusal of continuation, dissatisfaction with the efficacy, transition to SCIT, and adverse effects. Refusal of continuation increased with age, whereas transition to SCIT decreased with age. Ninety-seven cases transitioned from SLIT to SCIT, and the transition rates increased with time. Comorbid allergic asthma did not affect the transition rates. However, multi-sensitization was associated with a slightly higher rate of transition to SCIT. The most common reason for the transition was dissatisfaction with the efficacy (54.6%), which was only reported by patients older than 5 years. For children who began SLIT at younger than 5 years old, the most common reason (81.2%) for transition was age reaching 5 years.Conclusions: HDM-SLIT has a very high dropout rate, which is mainly due to refusal of continuation and dissatisfaction with the efficacy. Transitioning from SLIT to SCIT may help keep these patients on AIT and thus increase adherence and long-term efficacy.

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