J Otolaryngol Ophthalmol Shandong Univ ›› 2018, Vol. 32 ›› Issue (5): 71-74.doi: 10.6040/j.issn.1673-3770.0.2018.158

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Factors associated with systemic adverse reactions after subcutaneous immunotherapy injections and treatment options

WANG Tan, WU Ke, LI Lianqing, GONG Lili   

  1. Department of Otorhinolaryngology Head and Neck Surgery, Liaocheng Peoples Hospital, Liaocheng 252000, Shandong, China
  • Received:2018-03-26 Online:2018-09-20 Published:2018-09-20

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Abstract: Objective To analyze the factors associated with and the treatment of systemic adverse reactions after subcutaneous immunotherapy(SCIT)injections. Methods We retrospectively analyzed the records of patients with systemic anaphylaxis who presented to the Allergic Diseases Outpatient Department between January 2013 and December 2017. Results A total of 4597 SCIT injections had been administered to 191 patients, and 23 cases/instances of systemic adverse reactions were reported in 21 patients. The incidence of systemic adverse reactions was 0.5%. An immediate reaction was observed in 17 and a delayed reaction was observed in 6 cases. Systemic adverse reactions occurred during the initial treatment in 6 and during maintenance treatment in 17 cases. Based on the World Allergy Organization immunotherapy guidelines, 7 cases were classified as grade 1, 15 as grade 2, 1 as grade 3, 0 as grade 4, and 0 as grade 5. After exclusion of the associated factors, continuing to inject the original dose showed no adverse reactions. Conclusion Systemic reactions usually occur during the dose maintenance period. Alcohol intake, infections, ingestion or inhalation of a large number of allergens, hot water baths, exercise, fatigue, emotional stress, fasting, early pregnancy, and a few specific immunoglobulin E-mediated diseases are known risk factors for systemic adverse reactions in patients who receive multiple injections and tend to develop tolerance to the dose. Detailed questioning regarding the patients recent life history prior to each injection and careful assessment of the injector are important to reduce systemic allergic reactions. Continuing to inject the original dose after excluding the contributory factors is safe.

Key words: Allergic rhinitis, Subcutaneous immunotherapy, Systemic adverse reactions, Factors

CLC Number: 

  • R765.4
[1] Knisely AJ, Lee S. Advances in subcutaneous immunotherapy[J]. Curr Opin Otolaryngol Head Neck Surg, 2014, 22(3):216-220.
[2] 邱前辉,卢川,陈建军,等. 变应性鼻炎冲击免疫治疗的安全性研究[J]. 临床耳鼻咽喉头颈外科杂志,2014,28(11):776-779, 784. QIU Qianhui, LU Chuan, CHEN Jianjun, et al. Safety of rush allergen-specific immunotherapy in allergic rhinitis patients[J]. J Clin Otorhinolaryngol Head Neck Surg, 2014, 28(11):776-779, 784.
[3] 李琳,关桂梅,朱冬冬,等. 变应性鼻炎标准化螨变应原皮下免疫治疗患者的疗效及安全性[J]. 中华耳鼻咽喉头颈外科杂志,2012,47(6):445-448. LI Lin, GUAN Guimei, ZHU Dongdong, et al. Efficacy and safety analysis with standardized mite allergen subcutaneous immunotherapy in 90 patients with allergic rhinitis[J]. Chin J Otorhinolaryngol Head Neck Surg, 2012, 47(6):445-448.
[4] 程雷. 变应性鼻炎的特异性免疫治疗[J]. 山东大学耳鼻喉眼学报,2011,25(5):33-35.
[5] Lockey RF, Benedict LM, Turkeltaub PC, et al. Fatalities from inununotherapy(IT)and skin testing(ST)[J]. J Allergy Clin Immunol, 1987, 79(4):660-677.
[6] Reid MJ, Lockey RF, Turkelmub PC, et al. Survey of fatalities from skin testing and immunotherapy 1985-1989[J]. J Allergy Clin Immunol, 1993, 92(1):6-15.
[7] Bemstein DI, Wanner M, Bofish L, et al. Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990-2001[J]. J Allergy Clin lmmunol, 2004, 113(6):1129-1136.
[8] Epstein TG, Liss GM, Murphy-Berendts K, et al. AAAAI/ACAAI surveillance study of subcutaneous immunotherapy, years 2008-2012: an update on fatal and nonfatal systemic allergic reactions[J]. J Allergy and Clinl Immunol Pract, 2014, 2(2):161-167.
[9] Bernstein DI, Epstein T, Murphy-Berendts K, et al. Surveillance of systemic reactions to subcutaneous immunotherapy injections: year 1 outcomes of the ACAAI and AAAAI collaborative study[J]. Ann Allergy Asthma Immunol, 2010, 104(6):530-535.
[10] 中华耳鼻咽喉头颈外科杂志编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组. 变应性鼻炎诊断和治疗指南(2015年,天津)[J]. 中华耳鼻咽喉头颈外科杂志,2016,51(1):6-24. Subspecialty Group of Rhinology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery; Subspecialty Group of Rhinology, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association. Chinese guidelines for diagnosis and treatment of allergic rhinitis[J]. Chin J Otorhinolaryngol Head Neck Surg, 2016, 51(1): 6-24.
[11] Alvarez CE, Bousquet J, Canonica GW, et al. Standards for practical allergen-specific immunotherapy[J]. Allergy, 2006, 61(S82):1-20.
[12] Cox L, Nelson H, Lockey R, et al. Allergen immunotherapy:a practice parameter third update[J]. J Allergy Clin Immunol, 2001, 127(S1):1-55.
[13] Niggemann B, Jacobsen L, Dreborg S, et al. Five-year followup on the PAT study:specific immunotherapy and long-term prevention of asthma in children[J]. Allergy, 2006, 61(7):855-859.
[14] Pajno GB, Barberio G, De Luca F, et al. Prevention of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy. A six-year follow-up study[J]. Clin Exp Allergy, 2001, 31(9):1392-1397.
[15] Alvarez CE, Bousquet J, Canonica GW, et al. Standards for practical allergen-specific immunotherapy[J]. Allergy, 2006, 61(S82):1-20.
[16] Cox L, Nelson H, Lockey R, et al. Allergen immunotherapy: a practice parameter third update[J]. J Allergy Clin Immunol, 2011, 127(S1):1-55.
[17] Zuberbier T, Bachert C, Bousquet PJ, et al. GA2 LEN/EAACI pocket guide for allergen-specific immunotherapy for allergic rhinitis and asthma[J]. Allergy, 2010, 65(12):1525-1530.
[18] Cox L, Larenas-Linnemann D, Lockey RF, et al. Speaking the same language: the world allergy organization subcutaneous immunotherapy systemic reaction grading system[J]. Allergy Clin Immunol, 2010, 125(3):569-574.
[19] 李孟荣,王晓宁,姜晗丹,等. 变应哮喘鼻炎患者尘螨变应原皮下免疫治疗后不良反应234例分析及处理[J]. 中国儿科杂志,2012,50(10):726-731. LI Mengrong, WANG Xiaoning, JIANG Handan, et al. Analysis of adverse reactions induced by subcutaneous immunotherapy against dust mite allergy in 234 cases with allergic rhinitis and asthma[J]. Chin J Pediatr, 2012, 50(10):726-731.
[20] 祝凤霞,张融,徐金梅,等. 儿童屋尘螨变应原皮下特异性免疫疗法的不良反应分析[J].实用临床医药杂志,2013,17(22):196-197.
[21] 中国变应性鼻炎研究协作组. 变应性鼻炎皮下免疫治疗专家共识2015[J]. 中国耳鼻咽喉头颈外科,2015,22(8):379-404.
[22] Alvare-Cuesta E, Bousquet J, Canorica GW, et al. Standards for practical allergen-specific immunotherapy[J]. Allergy, 2006, 61(S82):1-20.
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