Prospective survey of local and systemic reactions to immunotherapy with pollen extracts

To assess the relative risk of local and systemic reactions to injections of pollen extracts and to examine the predictive value of these local reactions for systemic reactions, a prospective survey of local and systemic reactions was performed from October 1981 to June 1983 at a large military allergy clinic. Four hundred and sixteen patients received 26,645 injections of pollen extracts. Of the total, 25,508 injections (95.7%) were not associated with reactions, 1,055 injections (4.0%) were associated with local reactions (669, less than 2 cm in diameter; 279, 2 to 5 cm; and 107 greater than 5 cm), and 82 injections (0.3%) were associated with systemic reactions. Seventy patients experienced 82 systemic reactions. Of these, 25 (36%) had no prior local reactions. Eighteen males and 52 females had systemic reactions. The sensitivity of local reactions as a predictor of systemic reactions was 64%, the specificity was 1.2%, the positive predictive value was 12%, and the negative predictive value was 14%. Proportionally, more women than men experienced systemic reactions, P less than 0.05. We made the following conclusions. Most injections of pollen extracts were not associated with local or systemic reactions. The majority of reactions were local. The presence of local reactions was not helpful in predicting which patients would develop systemic reactions. Women appeared to be at greater risk for systemic reactions than men.