title: Allergen immunotherapy safety: characterizing systemic reactions and identifying risk factors.
abstract: Systemic reactions (SRs) pose a risk to those treated with subcutaneous allergen immunotherapy (AIT). The goals of the study were to calculate a rate of SRs to AIT, characterize the timing and treatment of these SRs, and analyze a case-control sample of patients for putative SR risk factors. A case-control study based on a retrospective chart review from 2004 to 2006 at a single institution was performed for patients receiving AIT. A control group received AIT over the same time period but did not have an SR. Three hundred thirty-eight patients had 10,497 AIT injection visits and 25 patients experienced 29 SRs for a rate of 0.28% per injection visit and 7.4% per patient. Gender, phase (build-up versus maintenance), asthma, angiotensin-converting enzyme inhibitors, beta-blockers, initial skin-prick test size, or allergen type did not increase the odds of an SR to AIT. Nearly one-half (48%) of the SRs occurred >30 minutes after the injection. All five patients with an abnormal physical exam or a >20% decrease in peak expiratory flow during their SRs occurred in patients presenting with their SRs >30 minutes after the injection (p = 0.02). This study found a low rate of SRs to AIT. However, a high percentage of SRs occurred >30 minutes after the injection, and many of these SRs required epinephrine. This study was unable to identify specific risk factors that predict SRs to AIT.
authors.affiliation: Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA. rank.matthew@mayo.edu
authors.forename: Mathew A
authors.initials: MA
authors.lastname: Rank
authors.forename: Corrine L
authors.initials: CL
authors.lastname: Oslie
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Krogman
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Park
authors.forename: James T
authors.initials: JT
authors.lastname: Li
mesh_terms: D000485:Allergens / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D003888:Desensitization, Immunologic / Q000009:adverse effects*; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy / Q000209:etiology*; D007279:Injections, Subcutaneous; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000485:Allergens; D004837:Epinephrine