How Should Allergists Deal With Local Reactions to Allergen Immunotherapy?

Tankersley, Michael S.

doi:10.1007/s11882-010-0172-5

Cited by 7 publications

(7 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[14][15][16] Systemic allergic reactions are a risk for SCIT and SLIT because intact allergens in these treatments can cross-link IgE molecules on the surfaces of mast cells and basophils, causing activation and degranulation and resulting in systemic allergic reactions. Other limitations of SCIT and SLIT include marked local side effects (eg, injectionsite swelling with SCIT, which can be prolonged, impressive, and dose limiting, and oral pruritus with SLIT), 15,[17][18][19] the risk of systemic allergic reactions (higher with SCIT than with SLIT 16 ) along with the need to provide patients with ''rescue'' epinephrine in the United States, lengthy (> _3 years) treatment necessary to achieve disease modification, 20,21 and the cost of long-term treatment. [22][23][24] Systematic reviews and meta-analyses show grass SLIT and SCIT to have a modest treatment benefit for symptom and medication score reduction in patients with seasonal ARC.…”

Section: Abbreviations Usedmentioning

confidence: 99%

Treatment with grass allergen peptides improves symptoms of grass pollen–induced allergic rhinoconjunctivitis

Ellis

Frankish

O’Hehir

et al. 2017

Journal of Allergy and Clinical Immunology

View full text Add to dashboard Cite

Section: Abbreviations Usedmentioning

confidence: 99%

Treatment with grass allergen peptides improves symptoms of grass pollen–induced allergic rhinoconjunctivitis

Ellis

Frankish

O’Hehir

et al. 2017

Journal of Allergy and Clinical Immunology

View full text Add to dashboard Cite

“…LRs are defined as any swelling located at or near the injection site following an allergen injection. 214 Many different size definitions have been used to differentiate an LR from an LLR. LLRs have been variously defined as (1) induration of >25 mm or 12-hour duration, (2) >20 mm or >24-hour duration, (3) >40 mm, and (4) larger than the size of the patient's palm (8-10 cm).…”

Section: Supporting Textmentioning

confidence: 99%

“…LLRs have been variously defined as (1) induration of >25 mm or 12-hour duration, (2) >20 mm or >24-hour duration, (3) >40 mm, and (4) larger than the size of the patient's palm (8-10 cm). 214,215 Historically, textbooks of allergy recommended dosage adjustments secondary to LLRs. 216 Adjustments were recommended as LLRs were considered to foretell a future SR should the SCIT dosage be increased.…”

Section: Supporting Textmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Practice Guideline: Immunotherapy for Inhalant Allergy

Gurgel,

Baroody,

Damask

et al. 2024

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

ObjectiveAllergen immunotherapy (AIT) is the therapeutic exposure to an allergen or allergens selected by clinical assessment and allergy testing to decrease allergic symptoms and induce immunologic tolerance. Inhalant AIT is administered to millions of patients for allergic rhinitis (AR) and allergic asthma (AA) and is most commonly delivered as subcutaneous immunotherapy (SCIT) or sublingual immunotherapy (SLIT). Despite its widespread use, there is variability in the initiation and delivery of safe and effective immunotherapy, and there are opportunities for evidence‐based recommendations for improved patient care.PurposeThe purpose of this clinical practice guideline (CPG) is to identify quality improvement opportunities and provide clinicians trustworthy, evidence‐based recommendations regarding the management of inhaled allergies with immunotherapy. Specific goals of the guideline are to optimize patient care, promote safe and effective therapy, reduce unjustified variations in care, and reduce the risk of harm. The target patients for the guideline are any individuals aged 5 years and older with AR, with or without AA, who are either candidates for immunotherapy or treated with immunotherapy for their inhalant allergies. The target audience is all clinicians involved in the administration of immunotherapy. This guideline is intended to focus on evidence‐based quality improvement opportunities judged most important by the guideline development group (GDG). It is not intended to be a comprehensive, general guide regarding the management of inhaled allergies with immunotherapy. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients.Action StatementsThe GDG made a strong recommendation that (Key Action Statement [KAS] 10) the clinician performing allergy skin testing or administering AIT must be able to diagnose and manage anaphylaxis. The GDG made recommendations for the following KASs: (KAS 1) Clinicians should offer or refer to a clinician who can offer immunotherapy for patients with AR with or without AA if their patients' symptoms are inadequately controlled with medical therapy, allergen avoidance, or both, or have a preference for immunomodulation. (KAS 2A) Clinicians should not initiate AIT for patients who are pregnant, have uncontrolled asthma, or are unable to tolerate injectable epinephrine. (KAS 3) Clinicians should evaluate the patient or refer the patient to a clinician who can evaluate for signs and symptoms of asthma before initiating AIT and for signs and symptoms of uncontrolled asthma before administering subsequent AIT. (KAS 4) Clinicians should educate patients who are immunotherapy candidates regarding the differences between SCIT and SLIT (aqueous and tablet) including risks, benefits, convenience, and costs. (KAS 5) Clinicians should educate patients about the potential benefits of AIT in (1) preventing new allergen sensitizations, (2) reducing the risk of developing AA, and (3) altering the natural history of the disease with continued benefit after discontinuation of therapy. (KAS 6) Clinicians who administer SLIT to patients with seasonal AR should offer pre‐ and co‐seasonal immunotherapy. (KAS 7) Clinicians prescribing AIT should limit treatment to only those clinically relevant allergens that correlate with the patient's history and are confirmed by testing. (KAS 9) Clinicians administering AIT should continue escalation or maintenance dosing when patients have local reactions (LRs) to AIT. (KAS 11) Clinicians should avoid repeat allergy testing as an assessment of the efficacy of ongoing AIT unless there is a change in environmental exposures or a loss of control of symptoms. (KAS 12) For patients who are experiencing symptomatic control from AIT, clinicians should treat for a minimum duration of 3 years, with ongoing treatment duration based on patient response to treatment. The GDG offered the following KASs as options: (KAS 2B) Clinicians may choose not to initiate AIT for patients who use concomitant beta‐blockers, have a history of anaphylaxis, have systemic immunosuppression, or have eosinophilic esophagitis (SLIT only). (KAS 8) Clinicians may treat polysensitized patients with a limited number of allergens.

show abstract

“…Side effects were documented at the time of each injection, including LR and SR. Erythema and/or swelling at the injection area were defined as large LR (≥4 cm in diameter) [19,20]. SRs were classified into 5 grades, ranging from grade 1 (symptoms of one organ system present) to grade 5 (death) according to the AIT Systemic Reaction Grading System proposed by WAO [21,22].…”

Section: Side Effectsmentioning

confidence: 99%

Safety of house dust mite subcutaneous immunotherapy in preschool children with respiratory allergic diseases

Yang

Huang

et al. 2021

Ital J Pediatr

View full text Add to dashboard Cite

Background Allergen immunotherapy (AIT) is the only causal therapy for IgE-mediated allergy. There is less evidence about the safety and efficacy of AIT especially subcutaneous immunotherapy (SCIT) in children under 5 years old. We aimed to investigate the side effects and associated risk factors of house dust mite (HDM) SCIT in preschool children with respiratory allergic diseases. Methods The preschool children who had HDM-related allergic rhinitis with/without asthma were enrolled and undergone standardized HDM SCIT in our department from June 2013 to December 2019. Local reactions (LRs) and systemic reactions (SRs) were recorded and categorized according to World Allergy Organization recommendations. Demographic data and other therapeutic-related parameters were also recorded to investigate potential risk factors for these side effects. Results A total of 91 children (60 boys, 65.93%; 31 girls, 34.07%; mean age 4.13 years old) were included in the study. Among the 91 patients, 3109 SCIT injections were recorded, 62/91 (68.13%) experienced 186 immediate LRs, 4 /91(4.40%) experienced 6 delayed LRs, 11/91 (12.09%) children experienced 44 immediate SRs, 21/44 (47.73%) were grade 1 SRs, 21/44 (47.73%) were grade 2, 2/44 (4.55%) were grade 3, no grade 4 or 5 SRs occurred. Furthermore, 1/91 (1.10%) experienced 1 delayed SRs, manifested by urticaria 2 days later after allergen injection. 9/91 (9.89%) experienced 2 or more times SRs. Multivariable logistic regression analysis showed BMI (OR 1.506; 95%CI 1.091 to 2.079; p < 0.05) and sIgE against HDM (OR 1.497; 95%CI 1.082 to 2.071; p < 0.05) were risk factors for LRs. No variable was found to correlate with SRs (all p > 0.05). Conclusions HDM subcutaneous immunotherapy is considered to be safe in preschool children with respiratory allergic diseases. Higher BMI and HDM sIgE level in children are risk factors for developing LRs. The incidence of SRs and the rate of severe SRs are low in preschool children.

show abstract

How Should Allergists Deal With Local Reactions to Allergen Immunotherapy?

Cited by 7 publications

References 26 publications

Treatment with grass allergen peptides improves symptoms of grass pollen–induced allergic rhinoconjunctivitis

Treatment with grass allergen peptides improves symptoms of grass pollen–induced allergic rhinoconjunctivitis

Clinical Practice Guideline: Immunotherapy for Inhalant Allergy

Safety of house dust mite subcutaneous immunotherapy in preschool children with respiratory allergic diseases

Contact Info

Product

Resources

About