Allergy Asthma Immunol Res.  2016 Sep;8(5):421-427. 10.4168/aair.2016.8.5.421.

Systemic Reactions to Dust Mite Subcutaneous Immunotherapy: A 3-Year Follow-up Study

• Dong X
• Huang N
• Li W
• Hu L
• Wang X
• Wang Y
• Xiang N
• Liu G
• Zhu R

• KMID: 2295151
• DOI: http://doi.org/10.4168/aair.2016.8.5.421

Abstract

PURPOSE
The incidence of allergen specific immunotherapy-related systemic reactions (SRs) varies among different studies, and many factors are likely to contribute to SRs. This study aims to investigate the incidence, characteristics, and risk factors of SRs to standardize dust mite-specific subcutaneous immunotherapy (SCIT) in Central China.
METHODS
All patients receiving standardized dust mites (100-100,000 SQ-U/mL; Alutard SQ, Hørsholn, Denmark) immunotherapy were followed up. Recorded data included demographics, diagnosis, patient status, pulmonary function testing results before and after each injection, allergen dosage, and details of SRs.
RESULTS
From June 2011 to August 2014, a total of 208 patients received 4,369 injections; 27 (13.0%) patients experienced 48 (1.1%) systemic reactions. Most of the SRs were grade 2 reactions (n=30, 62.5%), followed by grade 1 (n=11, 22.9%), grade 3 (n=7, 14.6%), and no fatal reactions occurred. Forty-six SRs (95.8%) occurred within 30 minutes. Higher SR rates were associated with high concentration extracts (100,000 SQ-U/mL), injections with concomitant local reactions (LRs), children, asthma and high sensitivity (skin prick test 3+/4+ and/or sIgE≥17.5 kUA/L) (P<0.05). The estimated odds of SRs increased in children (OR=6.57; 95% CI: 1.88-22.97, P=0.003), asthmatic patients (OR=4.10; 95% CI: 1.72-9.80, P=0.002), and injections with LRs (OR=2.41; 95% CI: 1.33-4.36, P=0.004).
CONCLUSIONS
The incidence of SRs to dust mite SCIT was low, and multiple factors were associated with the increased incidence of SRs. Children, asthmatics and patients with concomitant LR may be prone to develop SRs.

Keyword

Subcutaneous immunotherapy; systemic reactions; Dermatophagoides pteronyssinus; risk factors

MeSH Terms

Asthma
Child
China
Demography
Dermatophagoides pteronyssinus
Diagnosis
Dust*
Follow-Up Studies*
Humans
Immunotherapy*
Incidence
Mites*
Respiratory Function Tests
Risk Factors
Dust

Figure

• 

  Fig. 1 A higher incidence of SR in injections of high concentration extracts (No. 4 vial). Both the SR rates of injection of No. 4 vials in a build-up phase (1.71%) and a maintenance phase (1.78%) were significantly higher than those of No. 3 vials (0.33%) and No. 2 vials (0.32%) (P4B-3=0.012, P4B-2=0.011, P4M-3=0.009, P4M-2=0.009). However, there was no significant difference in SR rates of injection of No. 4 vials between the build-up and maintenance phases (P=0.9). *P<0.05; **P<0.01. B, build-up phase; M, maintenance phase.

• 

  Fig. 2 Age as a risk factor for systemic reactions. Boxplot demonstrating the age distribution of patients with/without SRs. The median (25th, 75th) ages were 7 (6, 12) in patients with SR and 15 (8, 33) in those without, and the differences were statistically significant (all P<0.001). Line inside the box=median. Bottom of the box=25th; top of the box=75th percentile. =outliers. Upper whisker=maximum observation below the upper fence (75th percentile +1.5 Q); lower whisker=minimum observation above the lower fence (25th percentile -1.5 Q); Q=quartile range.

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