Late and immediate systemic-allergic reactions to inhalant allergen immunotherapy

Systemic-allergic reactions to allergen immunotherapy were prospectively studied in four allergy treatment centers to assess frequency and specific attributes of these episodes relative to several variables. A total of 20,588 extract injections were administered to 628 patients. Forty-two patients experienced a systemic reaction (7%). Fifty-two systemic reactions occurred in total. Eight patients accounted for 18 of the reactions. Late systemic reactions, occurring from 35 minutes to 6 hours after injection, accounted for 38% of all reactions. Extracts containing only pollen antigens were more commonly associated with immediate and late systemic reactions relative to other extracts (p less than 0.001 and p less than 0.01, respectively). There were no significant reaction-rate differences whether immunotherapy was at maintenance or increasing doses or if the time of injection was during a pollinating or nonpollinating season. The most common clinical manifestations of the systemic reactions were generalized pruritus and urticaria. We conclude that patients receiving extracts containing only pollen antigens have increased systemic-allergic reaction rates. A subgroup of patients are at risk for recurrent reactions. Finally, late systemic reactions to immunotherapy are not rare events and pose a definite risk to the individual patient.