Fatalities from immunotherapy (IT) and skin testing (ST)

Area of Science:

• Allergy and Immunology
• Clinical Toxicology
• Public Health

Background:

• Fatalities associated with allergen immunotherapy (IT) and skin testing (ST) are infrequent but serious adverse events.
• Understanding the circumstances surrounding these rare deaths is crucial for improving patient safety in allergy diagnostics and treatment.

Purpose of the Study:

• To analyze the characteristics and potential causes of fatalities that occurred during or following allergen immunotherapy (IT) and skin testing (ST).
• To identify risk factors and contributing elements in fatal allergic reactions to inform preventative strategies.

Main Methods:

• Retrospective analysis of 46 reported fatalities since 1945, with complete data available for 30 cases (24 IT, 6 ST).
• Review of patient demographics, clinical presentation, administered allergens, co-administered medications, and timing of reactions.
• Categorization of potential contributing factors, including errors in administration, patient's disease state, and extract characteristics.

Main Results:

• Fifteen male and 15 female fatalities, aged 7-70 years (mean 33), were analyzed.
• Pollen extracts were implicated in 15 fatalities. Respiratory failure was the cause of death in 14/16 asthmatic patients.
• Fatalities associated with ST (n=6) were primarily due to intradermal testing without prior puncture testing. Errors in administration were noted in 3-6 cases.

Conclusions:

• While rare, fatalities can occur during IT and ST, with pollen extracts and respiratory compromise in asthmatics being significant factors.
• Patient's disease exacerbation, high sensitivity, and errors in administration contributed to some deaths.
• Implementing stringent precautions in patient selection, administration techniques, and prompt anaphylaxis management can further minimize the risk of fatal reactions.