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Systemic reactions and fatalities associated with allergen immunotherapy
R F Lockey1, G L Nicoara-Kasti, D S Theodoropoulos
1Department of Internal Medicine, University of South Florida College of Medicine, and James A. Haley Veterans' Medical Center, Tampa 33612, USA. rlockey@hsc.usf.edu
Summary
Systemic allergic reactions from allergen vaccines can occur minutes after injection, with severe reactions possible. Identifying and managing risk factors, especially for asthmatic patients, is crucial for safe allergen immunotherapy (IT).
Area of Science:
- Allergy and Immunology
- Clinical Medicine
Background:
- Allergen immunotherapy (IT) involves administering allergen vaccines to desensitize patients.
- Systemic allergic reactions, including anaphylaxis, are potential adverse events associated with IT and skin testing.
Purpose of the Study:
- To review systemic allergic reactions and associated risk factors linked to allergen vaccine injections.
- To inform clinical practice regarding the safe administration of allergen immunotherapy and skin testing.
Main Methods:
- A comprehensive literature review was performed.
- Data on anaphylactic reactions, adverse effects, and fatalities from allergen immunotherapy were analyzed.
- Expert opinion guided the selection of relevant literature.
Main Results:
- Systemic allergic reactions typically manifest within 20-30 minutes post-injection but can occur later.
- While most reactions to skin testing and IT are mild, severe and fatal events have been documented.
- Risk factors include asthma exacerbations, high allergen sensitivity, beta-blocker use, and rush immunotherapy protocols.
Conclusions:
- Strict adherence to risk factor identification and management protocols is essential before and after allergen testing and IT.
- Minimizing risks involves careful patient selection and appropriate procedural techniques.
- When administered correctly, allergen immunotherapy and skin testing carry minimal risk.