Systemic reactions to immunotherapy: influence of composition and manufacturer

Gastaminza, Gabriel; Algorta, Jaime; Audícana, M.; Etxenagusia, M.; Fernández, E.; Muñoz, D.

doi:10.1046/j.1365-2222.2003.01644.x

Cited by 45 publications

(27 citation statements)

References 14 publications

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“…A finding consistent with that reported by others [9,35,41] and not agreed with results of others [11,19,[42][43][44]. Although more than half of systemic reactions cases developed as immediate reactions, our results indicated an important aspect of development of 43% of systemic reactions were of late onsets.…”

Section: Discussionsupporting

confidence: 90%

“…Both Mould and HDM allergens systemic reactions development rates were significantly different (p<0.0001) from other inhalant allergens evaluated in this study. This finding was in consistent with some studies [19,32,40,41] and not with others [42]. Indoor allergens were a significant risk factor for development of systemic reactions to subcutaneous immunotherapy [OR=18.2, P<0.0001].…”

supporting

confidence: 91%

“…The reported rate of systemic reactions per injection has been variable from 0.06% to 2.033% [9,11,13,19,31,32,35,39,[42][43][44][45][46][47]. Our frequency of SRs was 0.21% and within the range reported by several studies.…”

Section: Discussionsupporting

confidence: 60%

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Systemic Adverse Reaction to Specific Immunotherapy

Alsamarai¹,

Alobaidi²,

Alwan³

et al. 2011

J Aller Ther

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Background: Allergen immunotherapy has been reported to be effective in reducing allergic symptoms and drug consumption in cases of respiratory allergy. However, some concerns still exist about the relative safety of allergen immunotherapy. This form of therapy has a potential risk of serious systemic reactions.Objective: To evaluate the frequency of systemic reactions due to subcutaneous allergen immunotherapy in Iraq and to identify factors associated with increased risk of adverse systemic reaction. Methods:From January 2000 to December 2008, we selected 693 patients with allergic rhinitis and asthma to receive subcutaneous specific immunotherapy. Prospective immunotherapy safety was evaluated by recording postinjection adverse effects. The adverse reaction observed during the administration of subcutaneous immunotherapy within a period of 9 years (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008), was analyzed in this study.Result: Data were obtained from 693 patients who received subcutaneous immunotherapy (SCIT). The mean number of skin tests positivity and number of injections were significantly higher in systemic reaction group compared to negative systemic reaction group. During the study period, a total of 39281 injections were administered to 693 patients. Of the 693 patients, 82 (11.8%) had systemic reaction, with an incidence of 2.1/1000 injection. Sixty nine of the 82 systemic reaction (84%) developed in the build up phase, versus 13 (16%) in the maintenance phase (p<0.0001), with respect to reaction time, 47 (57%) of the systemic reaction were immediate (within 30 minutes respect to reaction time), and 35 (43%) were delayed. There were higher significant influences of polysensitisation, age, asthma, combination of asthma and allergic rhinitis, type of allergen, and indoor allergens on the development of systemic adverse reactions to subcutaneous immunotherapy. Conclusion:The present study suggests that SCIT was a safe treatment with a low risk to elicit severe systemic reaction, in which no fatality was observed. Furthermore, this study indicated that mold, HDM, asthma, presence of asthma and allergic rhinitis (AR), polysensitisation, and indoor allergens sensitization were a risk factors contributing to systemic reactions. consents were obtained from all patients (or their parents for children) before the initiation of immunotherapy and the guidelines were followed to monitor patients during allergen extract injection. Systemic Adverse Reaction to Specific ImmunotherapyThe adverse reaction observed during the administration of subcutaneous immunotherapy within a period of 9 years (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008), was analyzed in this study. Demographic and clinical data and peak expiratory flow before and after injection were recorded by the investigators on a standardized form. Immunotherapy scheduleImmunotherapy was given in term of conventional schedule. Conventional Immunotherapy build-up was typically given as injection per week until the maintenance dose wa...

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Section: Discussionsupporting

confidence: 90%

supporting

confidence: 91%

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Systemic Adverse Reaction to Specific Immunotherapy

Alsamarai¹,

Alobaidi²,

Alwan³

et al. 2011

J Aller Ther

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“…There are several possibilities for this varying induction of IgG responses to Bet v 1 and the Bet v 1-related allergens. They include different genetically determined abilities of the patients to mount immune responses [23], different degrees of cross-reactivity among the Bet v 1-related allergens [24, 25] and possible heterogeneities of the raw allergen extracts used for treatment [26,27,28]. …”

Section: Discussionmentioning

confidence: 99%

Analysis of the Antibody Responses Induced by Subcutaneous Injection Immunotherapy with Birch and Fagales Pollen Extracts Adsorbed onto Aluminum Hydroxide

Gadermaier

Flicker

Aberer

et al. 2009

Int Arch Allergy Immunol

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Background: Allergen-specific subcutaneous immunotherapy (SCIT) is an antigen-specific therapy of IgE-mediated allergies. In the present study, we analyze the epitope specificities of antibody responses induced by SCIT with allergen extracts from pollen of trees belonging to the order Fagales (birch, alder, hazel) adsorbed onto aluminum hydroxide. Methods: The IgE, IgG1–4 and IgA responses to defined recombinant allergens (birch pollen: Bet v 1; alder pollen: Aln g 1; hazel pollen: Cor a 1; apple: Mal d 1) as well as to Bet v 1-derived recombinant fragments and synthetic peptides were analyzed in sera from patients who had undergone SCIT for different periods of time. Results: Long-term SCIT (>1 year; cumulative dose >1,000,000 SQ units) induced more pronounced IgG1, IgG2 and IgG4 responses to Bet v 1 and Bet v 1-related allergens according to the degree of sequence homology (Bet v 1>Aln g 1>Cor a 1>Mal d 1) than short-term SCIT (<1 year; cumulative dose <1,000,000 SQ units). In contrast to patients treated for <1 year, patients treated for >1 year mounted distinct IgG1, IgG2 and IgG4 responses against sequential Bet v 1 epitopes. No relevant allergen-specific IgA or IgG3 responses were induced by short- or long-term SCIT. Using a competitive ELISA assay, it could be shown that serum IgG from patients undergoing long-term SCIT inhibited IgE reactivity to Bet v 1 better than IgG from patients undergoing short-term SCIT. Conclusion: SCIT with allergen extracts adsorbed onto aluminum hydroxide induces IgG responses against new epitopes that block IgE binding and cross-react with structurally related allergens depending, among other factors, on duration of treatment and cumulative injected dose.

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“…Particular risk factors such as uncontrolled asthma, cluster treatment or allergen extracts from a particular manufacturer [12,13,14] were not present. Mix-up of extracts or wrong doses could not be identified.…”

Section: Introductionmentioning

confidence: 99%

Analysis of an Unusual Cluster of Systemic Reactions to Subcutaneous Specific Immunotherapy with Respiratory Allergens in One Allergy Center

Scherer¹,

Schindler

Arnold³

et al. 2011

Int Arch Allergy Immunol

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Systemic reactions to subcutaneous immunotherapy occur despite all necessary precautions and experienced staff and should prompt a search for causative factors. We present an analysis of 11 reactions, 8 of them within a short period. The patients and reactions were evaluated regarding extract errors (composition, concentration), dosing errors, ignored contraindications to specific subcutaneous immunotherapy, introductions versus maintenance phase and accidental intravascular injection. No single or common cause could be identified. Statistical analysis suggests that exceptional clusters of systemic reactions such as these may be just random cumulations without identifiable cause.

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Systemic reactions to immunotherapy: influence of composition and manufacturer

Cited by 45 publications

References 14 publications

Systemic Adverse Reaction to Specific Immunotherapy

Systemic Adverse Reaction to Specific Immunotherapy

Analysis of the Antibody Responses Induced by Subcutaneous Injection Immunotherapy with Birch and Fagales Pollen Extracts Adsorbed onto Aluminum Hydroxide

Analysis of an Unusual Cluster of Systemic Reactions to Subcutaneous Specific Immunotherapy with Respiratory Allergens in One Allergy Center

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