Pediatr Allergy Respir Dis.  2011 Sep;21(3):238-241.

A Case of Anaphylaxis after the First Dose of Sublingual Immunotherapy with House Dust Mite

Affiliations
  • 1Department of Pediatrics, Eulji University School of Medicine, Seoul, Korea. phyoung@eulji.ac.kr

Abstract

The advantages of sublingual immunotherapy (SLIT) are its friendly route of administration and less frequent occurrence of severe side-effects. The most frequently reported events were irritation of the throat and oral itching. According to the recent data, the number of side effects seems to be dose-dependent. We report on one case of anaphylaxis after the first dose of SLIT with house dust mite drop. A 10-year-old girl suffered from severe allergic rhinitis with perennial symptoms and asthma for which a low dose inhaled corticosteroid was used. Her allergy workup disclosed a positive skin prick test to Dermatophagoides pteronyssinus, Dermatophagoides farinae, birch, hazel tree, alder, dog, cat, platane, and acacia pollens. We started SLIT (Pangramin SLIT, ALKAbello, Madrid, Spain) with D. pteronyssinus and D. farinae. Fifteen minutes after the first dose taken at home, she experienced local irritation, lip swelling, facial rash, rhinorrhea and cough. Provocation test was performed in the clinic with the same drug (0.00015 microg/drop, 1.6 STU/mL of D. pteronyssinus and D. farinae, respectively). After twenty minutes, she reported lip swelling, perioral wheals, rash and cough. Wheezing was aggravated, and peak expiratory flow rate (PEFR) dropped by 13% compared to prechallenge PEFR. We stress to have the first dose of SLIT taken in the clinic with an observation period.

Keyword

Sublingual immunotherapy; Anaphylaxis

MeSH Terms

Acacia
Alnus
Anaphylaxis
Animals
Asthma
Betula
Cats
Child
Cough
Dermatophagoides farinae
Dermatophagoides pteronyssinus
Dogs
Dust
Exanthema
Humans
Hypersensitivity
Immunotherapy
Lip
Peak Expiratory Flow Rate
Pharynx
Pollen
Pruritus
Pyroglyphidae
Respiratory Sounds
Rhinitis
Rhinitis, Allergic, Perennial
Skin
Trees
Dust

Reference

References

1. Krouse JH. Sublingual immunotherapy for inhalant allergy: cautious optimism. Otolaryngol Head Neck Surg. 2009; 140:622–4.
2. Di Rienzo V, Marcucci F, Puccinelli P, Parmiani S, Frati F, Sensi L, et al. Long-lasting effect of sublingual immunotherapy in children with asthma due to house dust mite: a 10-year prospective study. Clin Exp Allergy. 2003; 33:206–10.
Article
3. Marogna M, Tomassetti D, Bernasconi A, Colombo F, Massolo A, Businco AD, et al. Preventive effects of sublingual immunotherapy in childhood: an open randomized controlled study. Ann Allergy Asthma Immunol. 2008; 101:206–11.
Article
4. Scadding GK, Durham SR, Mirakian R, Jones NS, Leech SC, Farooque S, et al. BSACI guidelines for the management of allergic and nonallergic rhinitis. Clin Exp Allergy. 2008; 38:19–42.
Article
5. Stewart GE 2nd, Lockey RF. Systemic reactions from allergen immunotherapy. J Allergy Clin Immunol. 1992; 90(4 Pt 1):567–78.
Article
6. Tari MG, Mancino M, Monti G. Efficacy of sublingual immunotherapy in patients with rhinitis and asthma due to house dust mite. A double-blind study. Allergol Immunopathol (Madr). 1990; 18:277–84.
7. Guez S, Vatrinet C, Fadel R, André C. House-dust-mite sublingual-swallow immunotherapy (SLIT) in perennial rhinitis: a double-blind, placebocontrolled study. Allergy. 2000; 55:369–75.
Article
8. Cohen SG, Evans R 3rd. Allergen immunotherapy in historical perspective. Clin Allergy Immunol. 2004; 18:1–36.
9. Agostinis F, Foglia C, Landi M, Cottini M, Lombardi C, Canonica GW, et al. The safety of sublingual immunotherapy with one or multiple pollen allergens in children. Allergy. 2008; 63:1637–9.
Article
10. Dunsky EH, Goldstein MF, Dvorin DJ, Beleca-nech GA. Anaphylaxis to sublingual immunotherapy. Allergy. 2006; 61:1235.
Article
11. Antico A, Pagani M, Crema A. Anaphylaxis by latex sublingual immunotherapy. Allergy. 2006; 61:1236–7.
Article
12. Eifan AO, Akkoc T, Yildiz A, Keles S, Ozdemir C, Bahceciler NN, et al. Clinical efficacy and immunological mechanisms of sublingual and subcutaneous immunotherapy in asthmatic/rhi-nitis children sensitized to house dust mite: an open randomized controlled trial. Clin Exp Allergy. 2010; 40:922–32.
Article
13. Blazowski L. Anaphylactic shock because of sublingual immunotherapy overdose during third year of maintenance dose. Allergy. 2008; 63:374.
14. de Groot H, Bijl A. Anaphylactic reaction after the first dose of sublingual immunotherapy with grass pollen tablet. Allergy. 2009; 64:963–4.
Article
15. Rhee CS. Immunotherapy for allergic rhinitis: current and future. Korean J Otolaryngol-Head Neck Surg. 2005; 48:1312–22.
16. Lombardi C, Gargioni S, Cottini M, Canonica GW, Passalacqua G. The safety of sublingual immunotherapy with one or more allergens in adults. Allergy. 2008; 63:375–6.
17. Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report–second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Ann Emerg Med. 2006; 47:373–80.
Article
18. Simons FE. Anaphylaxis. J Allergy Clin Immunol. 2010; 125(2 Suppl 2):S161–81.
Article
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