During a 1-year period, 27 otolaryngic allergy practices recorded all systemic reactions to immunotherapy resulting from 635,600 patient visits and 1,144,000 injections. Sixty percent of injections were given at home. Major systemic reactions were observed after 0.005% of injections. There were no hospitalizations or deaths. Eighty-seven percent of major reactions began within 20 minutes of injection. Frequently observed risk factors for major reactions were buildup phase of immunotherapy, active asthma, and first injection from a treatment vial. Home and office injections had similar rates of total systemic reactions, but home-based immunotherapy had far fewer major reactions. Home-based immunotherapy was found to be safe. The methods and precautions used to treat patients with this degree of safety are specified and discussed.
Get full access to this article
View all access options for this article.
References
1.
GreinederDK.Risk management in allergen immunotherapy. J Allergy Clin Immunol1996; 98:S330–4.
2.
GibofskyA.Legal issues in allergy and clinical immunology. J Allergy Clin Immunol1996; 98:S334–8.
3.
GordonB.Allergy skin tests and immunotherapy: comparison of methods in common use. Ear Nose Throat J1990; 69:47–62.
4.
AnonJB.Introduction to in vivo allergy testing. Otolaryngol Head Neck Surg1993; 109:593–600.
5.
FadalRG.Experience with RAST-based immunotherapy. Otolaryngol Clin North Am1992; 25:43–60.
6.
DavisWECookPRMcKinseyJPAnaphylaxis in immunotherapy. Otolaryngol Head Neck Surg1992; 107:78–83.
7.
CookPRBryantJLDavisWESystemic reactions to immunotherapy: the American Academy of Otolaryngic Allergy morbidity and mortality survey. Otolaryngol Head Neck Surg1994; 110:487–93.
8.
CraigTJMoeckliJK.Noncompliance with immunotherapy secondary to adverse effects [letter]. Ann Allergy Asthma Immunol1995; 75:290.
9.
AAAAI Board of Directors.Guidelines to minimize the risk of systemic reactions caused by immunotherapy with allergenic extracts. J Allergy Clin Immunol1994; 93:811–2.
Van ArsdelPPJrShermanWB.The risk of inducing constitutional reactions in allergic patients. J Allergy1957; 28:251–61.
13.
LockeyRFBenedictLMTurkeltaubPCFatalities from immunotherapy and skin testing. J Allergy Clin Immunol1987; 79:660–77.
14.
NormanPS.Safety of allergen immunotherapy [editorial]. J Allergy Clin Immunol1989; 84:438–9.
15.
TinkelmanDGColeWQTunnoJ.Immunotherapy: a one-year prospective study to evaluate risk factors of systemic reactions. J Allergy Clin Immunol1995; 95:8–14.
16.
VervloetDKhairallahEArnaudAA prospective national study of the safety of immunotherapy. Clin Allergy1980; 10:59–64.
17.
BosquetJMichelFB.Safety considerations in assessing the role of immunotherapy in allergic disorders. Drug Safety1994; 10:5–17.
18.
HejjaouiADhivertHMichelFBImmunotherapy with a standardized Dermatophagoides pteronyssinus extract: IV. systemic reactions according to the immunotherapy schedule. J Allergy Clin Immunol1990; 85:473–9.
ReidMJLockeyRFTurkeltaubPCSurvey of fatalities from skin testing and immunotherapy 1985–1989. J Allergy Clin Immunol1993; 92:6–15.
26.
ReidMJLockeyRFTurkeltaubPCFatalities from immunotherapy [abstract]. J Allergy Clin Immunol1992; 89:350.
27.
BrockowKKiehnMRiethmullerCEfficacy of antihistamine pretreatment in the prevention of adverse reactions to hymenoptera immunotherapy: a prospective, randomized, placebo-controlled trial. J Allergy Clin Immunol1997; 100:458–63.
28.
PortnoyJBagstadKKanarekHPremedication reduces the incidence of systemic reactions during inhalant rush immunotherapy with mixtures of allergenic extracts. Ann Allergy1994; 73:409–18.
29.
NielsenLJohnsenCRMosbechHAntihistamine pre-medication in specific cluster immunotherapy: a double-blind, placebo-controlled study. J Allergy Clin Immunol1996; 97:1207–13.
30.
GardulfAAndersenVBjorkanderJSubcutaneous immunoglobulin replacement in patients with primary antibody deficiencies: safety and costs. Lancet1995; 345:365–9.
31.
BooneDJSteindelSDHerronRTransfusion medicine monitoring practices. Arch Pathol Lab Med1995; 119:999–1006.
32.
NicholsMD.Transfusion: morbidity and mortality. Anaesth Intensive Care1993; 21:15–9.
33.
ErffmeyerJE.Reactions to antibiotics. Immunol Allergy Clin North Am1992; 12:633–48.
34.
WinberySLLiebermanPL.Anaphylaxis. Immunol Allergy Clin North Am1995; 15:447–75.
35.
MatloffSMBailitIWParksPSystemic reactions to immunotherapy. Allergy Proc1993; 14:347–50.
36.
BusincoLZanninoLCantaniASystemic reactions to specific immunotherapy in children with respiratory allergy: a prospective study. Pediatr Allergy Immunol1995; 6:44–7.
37.
McVayPAAndrewsAHoagMSModerate and severe reactions during autologous blood donations are no more frequent than during homologous blood donations. Vox Sang1990; 59:70–2.
38.
MabryRL.Skin endpoint titration. New York: Thieme; 1992.
