Shortened immunotherapy dose‐escalation saves time, but is it safe? A case‐control study comparing the rates of adverse reactions between conventional and fast‐escalation subcutaneous immunotherapy protocols during the induction phase

Abstract

Background-Allergen immunotherapy (AIT) is the only intervention believed to change the course of atopic diseases. As dogs appear to have fewer severe adverse events (AEs) compared to people receiving AIT, a prolonged dose-escalation induction phase might not be needed. Objectives-To report the incidence and characteristics of AEs induced by a fast-escalation subcutaneous immunotherapy (f-SCIT) protocol compared to a conventional (c-SCIT) regimen. Animals-One hundred dogs treated with either f-SCIT (Centre 1, 50 dogs) or c-SCIT (Centre 2, 50 dogs). Methods and materials-A case-control study retrospectively evaluating AEs during the induction of AIT. We determined the incidence and type of AEs in each SCIT group; we also assessed factors such as self-limitation and the need for AE-associated protocol changes. Results-Twelve of 100 dogs (12%) developed a SCIT-attributable AE during the induction phase, with one dog having a local and 11 having systemic reactions (nine Grade I, two Grade II, none of grades III or IV). Dogs treated with the f-SCIT had a significantly higher rate of AEs (11 of 50; 22%) compared to those receiving the c-SCIT (one of 50; 2%). Most of the AEs (10 of 11; 91%) in the f-SCIT group were mild and self-limiting. Conclusions and clinical importance-The induction phase of f-SCIT is simpler, and the maintenance phase is reached faster than that of the c-SCIT. Despite its higher rate of AEs than with the c-SCIT regimen, the majority of f-SCIT-associated AEs were mild and self-limiting. Whether or not this f-SCIT protocol leads to a faster time-toefficacy needs to be determined.

A randomised, double‐blinded comparison between subcutaneous rush and intralympathic allergen immunotherapy induction in atopic dogs

“…With RIT, the induction period is abbreviated, often from 4 weeks down to 1 day 14–16 . In human medicine, RIT provides earlier clinical improvement and improved convenience, although it is associated with a higher risk of systemic adverse events, 13 which is why RIT in humans is conducted in a hospital setting.…”

“…With RIT, the induction period is abbreviated, often from 4 weeks down to 1 day. [14][15][16] In human medicine, RIT provides earlier clinical improvement and improved convenience, although it is associated with a higher F I G U R E 1 Total scores of dogs treated with intralymphatic injections (ILIT) and rush immunotherapy (RIT) before (total_score_0) and after 1 month (total_score_30), 3 months (total_score_90), 6 months (total_score_180) and 12 months (total_score_360). Significant differences to baseline (day 0) are marked with an asterisk and the corresponding p-value.…”

“…Different rush protocols have been reported in the management of atopic dogs. [14][15][16] RIT also is described in two feline case studies, although a long-term therapeutic outcome has not been reported in that species. 17,18 Longterm, a good-to-excellent response to RIT was seen in 70% of the dogs in a retrospective study, 19 and total scores (reflecting the severity of cAD) decreased by >50% in 45% of the dogs in a prospective, doubleblinded study.…”

Adverse events associated with venomous insect immunotherapy and clinical outcomes in 82 dogs (2002–2020)

“…Adverse events were graded using a five-point grading system proposed by the World Allergy Organization which previously has been modified to grade adverse events related to immunotherapy in veterinary medicine. [10][11][12][13] Reactions were graded LR for local reactions and I-IV for systemic reactions (Table 1). Reactions which were attributed to immunotherapy which did not fall into this grading scale were classified based on the type of reaction and considered separately from the grading system.…”

“…Grading scale for venom immunotherapy and venomous insect sting associated local and systemic adverse events (adapted from Herrmann et al13 ) two) and vizsla (two), with one each of Akita, American pit bull terrier, Australian cattle dog, beagle, Belgian Malinois, Boston terrier, cavalier King Charles spaniel, cockapoo, English setter, Pembroke Welsh corgi, Rhodesian ridgeback, miniature schnauzer, soft-coated Wheaten terrier and standard poodle. Reported comorbidities included atopic dermatitis (20), cutaneous adverse food reaction (six), patellar luxation (two) and a nonspecified seizure disorder (two).…”