Santos N, Pereira AM, Plácido JL, Castel-Branco MG. Subcutaneous Specific Immunotherapy: local and systemic reactions. Allergy 2010;65(Suppl.92):568.

1. Santos, Natacha; Pereira, Ana Margarida; Plácido, José Luís; Castel-Branco, Maria da Graça. Hospital de São João, EPE, Porto, Portugal
Local and systemic reactions are a known complication of subcutaneous
specific immunotherapy (SCIT).
Our aim was to evaluate the frequency and severity of these reactions to
SCIT administration in our hospital.
Local reactions were classified as immediate (occurring within 30 minutes) or
late (debut >30 minutes after injection) and according to swelling size (<5
cm, 5-8 cm or > 8 cm).
Systemic reactions were classified according to EAACI, Immunotherapy Task
Force (JACI 2006:61:S82).
A total of 517 patients were treated with SCIT in our clinic during this 2 year
period: 59,6% female, with a median age of 21, ranging from 4 to 68 years
old. Most of our patients had allergic rhinitis (Graphic 1) and underwent
polymerized SCIT (96,3%) to mites (47,1%) or pollen (43.9%).
Local reactions occurred in a total of 205 (39,7%) patients :
8 patients presented systemic reactions:
Local swellings with <5 cm were common and are to be expected; they were well tolerated and do not require any specific therapy.
Larger local reactions were rare.
Despite their rarity, severe systemic reactions can occur. Our division is equipped and prepared to deal with cases such as
anaphylactic shock.
The Patient Immunotherapy Record Form is a useful tool for immunotherapy administration and adverse reactions surveillance.
Table 1. EAACI Grading of Severity for Systemic Reactions
I
Mild - localized urticaria, rhinitis or mild asthma (PF* < 20%
decrease)
II
Moderate - slow onset (>15 min) of generalized urticaria and/or
moderate asthma (PF < 40% decrease)
III
Severe - rapid onset (<15 min) of generalized urticaria,
angioedema or severe asthma (PF > 40% decrease)
IV
Anaphylactic shock – immediate generalized urticaria, stridor
(angioedema), asthma, hypotension
Graph 1: Prevalence of allergic diseases in patients undergoing SCIT
Asthma
Rhinitis
Asthma + Rhinitis
Rhinoconjuntivits
Asthma + Rhinoconjuntivitis
These reactions were more frequent in women (70,2%, p<0,001) and in
patients under depot immunotherapy (Graphic 4). There was no association of
local reactions with age, type of allergic disease or vaccine composition.
4 mild reactions
3 moderate reactions
1 anaphylactic shock
all during induction phase of SCIT
2 of them with depot immunotherapy
78,9%
39,1%
21,1%
60,9%
Depot
Polimerized
With local reactions Without local reactions
(498 patients)
(19 patients)
p<0,001*
27 year old female with allergic rhinitis in
the maintenance phase of SCIT to house
dust mites.
Prompt care was provided
Of the patients enrolled to SCIT in this period, 39 abandoned therapy, of
which 3 had presented with systemic reactions.
Graphic 4: Proportion of patients under polimerized and depot immunotherapy with local reactions.
* using Chi-Square Test
1,9%
26,7%
30,2%
12,8%
28,2%
Graphic 2: Number of patients with local reactions according to time of onset and severity
98,6% with
papules < 5 cm
79
Immediate
62
Late
64
Both 81,7% with
papules < 5 cm
*PF: Peak Flow decrease from baseline
Introduction
We performed a retrospective study with data collected from a Patient
Immunotherapy Record Form involving all patients who began treatment
with SCIT to aeroallergens in our division from January 2008 to December
2009.
Methods
Results
30,7%
28,7% 40,6%
Induction Maintenance
Graphic 3: Patients with local reactions according to immunotherapy phase
Induction + Maintenance