title: Late systemic-allergic reactions to inhalant allergen immunotherapy.
abstract: Late systemic-allergic reactions (defined as occurring between 30 minutes and 6 hours after injection) to inhalant allergen immunotherapy were prospectively studied in four allergy treatment centers; 35,674 injections were administered to 712 patients. Twenty-nine patients (4% of all patients) experienced 33 late reactions. Fifty-six injections (0.16% of all injections) were associated with the 33 late reactions. The most common clinical manifestation of a late reaction was urticaria. However, objective respiratory airway involvement, as manifested by wheezing and/or stridor, occurred in 10 (27%) of the late reactions. Delayed reactions involving wheezing and/or stridor were only related to injections from maintenance vials, and all these more severe reactions occurred no later than 60 minutes after injection. We conclude that late systemic-allergic reactions account for a significant percent of the total number of systemic-allergic reactions to inhalant allergen immunotherapy. It is our belief that a 60-minute postinjection waiting period for injections administered from maintenance vials of extract would enhance the safety of inhalant allergen immunotherapy.
authors.affiliation: Allergy and Immunization Clinic, Womack Army Community Hospital, Fort Bragg, N.C.
authors.forename: M A
authors.initials: MA
authors.lastname: Greenberg
authors.forename: C R
authors.initials: CR
authors.lastname: Kaufman
authors.forename: G E
authors.initials: GE
authors.lastname: Gonzalez
authors.forename: Z P
authors.initials: ZP
authors.lastname: Trusewych
authors.forename: C D
authors.initials: CD
authors.lastname: Rosenblatt
authors.forename: R J
authors.initials: RJ
authors.lastname: Summers
mesh_terms: D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000209:etiology* / Q000503:physiopathology; D007167:Immunotherapy / Q000009:adverse effects*; D007267:Injections; D008297:Male; D012135:Respiratory Sounds / Q000209:etiology; D013997:Time Factors; D014581:Urticaria / Q000209:etiology