Systemic reactions to specific immunotherapy in children with respiratory allergy: a prospective study

Abstract

The aim of this multi-centre prospective study was to evaluate the prevalence of systemic reactions to specific immunotherapy in children with allergic asthma and or rhinitis. One thousand and fifty-six children (653 boys and 403 girls), median age 8.5 years, were enrolled in this three-year prospective study. All the children were treated with injections of the following allergenic extracts: 689 of house dust mite, 291 of grass, 109 of Parietaria, 13 of Alternaria, 6 of Artemisia and 11 of Olea. Among 1056 treated children, 41 (3.7%) had systemic reactions: 40 children (3.7%) experienced mild symptoms such as asthma and/or urticaria, and only one shock (0.08%). A total of 47,247 injections were administered, and the rate of systemic reactions, according to the number of total injections was only 0.08%. According to the allergenic extract, systemic reactions occurred in 29/689 children (4.2%) treated with house dust mites extract (0.09% of the injections), in 9/291 children (3.1%) treated with grass extract (0.07% of the injections) and in 3/109 children (2.8%) treated with Parietaria extract (0.06% of the injections). The prevalence of systemic reactions was significantly higher (p < 0.0001) in the children treated with house dust mite extract in comparison with those treated with pollen extracts. All the systemic reactions appeared within 30 minutes following the administration of the extract and occurred in 37/41 cases (90.2%) with the same dose, previously tolerated. Most reactions were mild, and were readily controlled by immediate emergency treatment. There was no need for hospitalization.(ABSTRACT TRUNCATED AT 250 WORDS)

Side effects during subcutaneous immunotherapy in children with allergic diseases

“…Yet, a wide spectrum of side effects may occur due to the application of SCIT, ranging from mild local reactions to severe systemic anaphylactic reactions, potentially limiting its practical application . Concerning adult patients, multiple studies show diverging rates of systemic reactions, ranging from 2.4% to 50% of all patients and approximately 0.2% of all injections . The rare studies investigating systemic side effects in children indicate lower rates of <4% of all patients, respectively, <0.1% of all injections .…”

“…Concerning adult patients, multiple studies show diverging rates of systemic reactions, ranging from 2.4% to 50% of all patients and approximately 0.2% of all injections . The rare studies investigating systemic side effects in children indicate lower rates of <4% of all patients, respectively, <0.1% of all injections . Reliable data show that up to 80% of adults experience local reactions during SCIT .…”

Safety of sublingual-swallow immunotherapy in children aged 3 to 7 years

“…[1][2][3] SLIT is gaining clinical acceptance, although no consensus exists regarding its efficacy. 4 SLIT has been proposed as particularly appropriate and safe for children, 5 but few safety data have targeted pediatric populations.…”

Clinical practice

“…Patients and their caregivers need to be informed about these local reactions, and first dose should be given under medical surveillance [20]. Severe, lifethreatening systemic adverse reactions occur very rarely in SCIT and scarcely in sublingual allergen-specific immunotherapy (SLIT) [22,85,118]. According to the Paul Ehrlich Institute (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000), the incidence of side effects was 0.002-0.0076% for non-modified allergen extracts and 0.0005-0.01% for chemically modified allergen extracts (allergoids) [81].…”