The local and systemic side-effects of venom and inhaled-allergen subcutaneous immunotherapy.
BACKGROUND
Although immunotherapy is effective in allergic rhinitis, conjunctivitis, asthma and stinging insect hypersensitivity, it carries a risk of anaphylactic reactions.


METHODS
In a 4-year retrospective survey, we investigated 1257 adult patients who had received venom or inhaled-allergen subcutaneous immunotherapy. The dose-increase phase was performed as the 2-day rush protocol for venom immunotherapy and the 6-week protocol for inhaled-allergen immunotherapy.


RESULTS
A total of 904 patients received venom immunotherapy and 353 patients inhaled-allergen immunotherapy. The prevalence of systemic reactions was 13.6%. The frequency of systemic reactions was higher during the maintenance phase than in the dose-increase phase (9.6% vs. 5.9%) and was highest in both phases of treatment with honeybee venom (P < 0.001). The majority of systemic reactions were mild. Five (0.4%) patients had reaction with a fall of blood pressure and were treated with adrenaline. There was no fatal outcome. The systemic side-effects during the dose-increase phase of venom immunotherapy occurred at a median dose of 46 microg (range 2-100 microg). Large local reactions occurred in 13.9% of patients without any significant difference between the allergens.


CONCLUSIONS
We have shown that systemic reactions are not rare even during maintenance phase in patients with a well tolerated dose-increase phase of treatment. The most prominent risk factor for systemic reactions was immunotherapy with honeybee extract.
Adamic
Katja
K
University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia. katja.adamic@klinika-golnik.si
Zidarn
Mihaela
M
Bajrovic
Nissera
N
Erzen
Renato
R
Kopac
Peter
P
Music
Ema
E
D000280:Administration, Inhalation; D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000485:Allergens / Q000009:adverse effects* / Q000276:immunology*; D000707:Anaphylaxis / Q000276:immunology*; D001249:Asthma / Q000276:immunology* / Q000628:therapy*; D001514:Bee Venoms / Q000009:adverse effects* / Q000276:immunology*; D003233:Conjunctivitis, Allergic / Q000276:immunology / Q000628:therapy*; D003430:Cross-Sectional Studies; D003888:Desensitization, Immunologic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology* / Q000628:therapy*; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012221:Rhinitis, Allergic, Perennial / Q000276:immunology / Q000628:therapy*; D006255:Rhinitis, Allergic, Seasonal / Q000276:immunology* / Q000628:therapy*; D012307:Risk Factors; D017524:Slovenia; D014581:Urticaria / Q000276:immunology*; D014688:Venoms / Q000009:adverse effects* / Q000276:immunology*; D014862:Wasp Venoms / Q000009:adverse effects* / Q000276:immunology*; D055815:Young Adult
D000319:Adrenergic beta-Antagonists; D000485:Allergens; D001514:Bee Venoms; D014688:Venoms; D014862:Wasp Venoms