title: Comparison of systemic reactions in rush, cluster, and standard-build aeroallergen immunotherapy.
abstract: Given the choice of standard, cluster, and rush build-up for aeroallergen immunotherapy, standard-build immunotherapy has generally been preferred because of a perceived high rate of systemic reactions (SRs) associated with cluster and rush immunotherapy.
  
  
  
  To characterize the incidence of SRs during standard, cluster, and rush build-up immunotherapy in an allergy practice during a 5-year period.
  
  
  
  A retrospective review was conducted among patients receiving standard-build, 8- to 10-step cluster, or 2-day rush immunotherapy from January 1, 2010, through December 31, 2014, at Family Allergy & Asthma clinics in Louisville, Kentucky. Investigators excluded reactions that occurred during skin prick testing, venom immunotherapy, and not-true SRs, and identified the build-up method, age, sex, date of reaction, vial concentration, and presence of asthma. Per-shot and per-patient incidence of SRs was computed from these data.
  
  
  
  During our review period, 2,549,643 injections were administered to 11,982 patients. Per-shot incidence of SR was 0.01%, 0.06%, and 0.33% for standard, cluster, and rush immunotherapy, respectively; per-patient incidence of SR was 2.84%, 2.52%, and 11.86% for standard, cluster, and rush immunotherapy, respectively. A total of 42% of SRs were grade 1, 43% were grade 2, 12% were grade 3, and 3% were grade 4. No fatalities were reported. A total of 70% of total SRs, 75% of cluster SR, and 55% of rush SR occurred in females, with an emergent peak in SR from May to October.
  
  
  
  Compared with previously published rates, we observed a decrease in the incidence of SR for standard, cluster, and rush immunotherapy, with peak seasonality from May to October and a female predominance.
authors: Department of Pediatrics, University of Louisville, Louisville, Kentucky. Electronic address: andrew.winslow@louisville.edu.
authors: Andrew W
authors: AW
authors: Winslow
authors: Family Allergy & Asthma, Louisville, Kentucky.
authors: Joseph C
authors: JC
authors: Turbyville
authors: Family Allergy & Asthma, Louisville, Kentucky.
authors: J Wesley
authors: JW
authors: Sublett
authors: Family Allergy & Asthma, Louisville, Kentucky.
authors: James L
authors: JL
authors: Sublett
authors: Family Allergy & Asthma, Louisville, Kentucky.
authors: Stephen J
authors: SJ
authors: Pollard
mesh_terms: D000485:Allergens / Q000008:administration & dosage* / Q000009:adverse effects*; D003888:Desensitization, Immunologic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male
chemical_list: D000485:Allergens