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Nonfatal systemic allergic reactions induced by skin testing and immunotherapy
1University of Pittsburgh School of Medicine, Department of Pediatrics, Pennsylvania.
Annals of Allergy
|December 1, 1993
Summary
Systemic allergic reactions from skin testing are rare (<0.02%), but immunotherapy carries a 2.9% risk. Key factors include allergen type, dose escalation rate, and patient sensitivity, with prick tests aiding risk assessment.
Area of Science:
- Allergy and Immunology
- Clinical Research
Background:
- Systemic allergic reactions (SARs) are a known risk of allergen immunotherapy (AIT) and skin testing.
- Identifying predictive factors for SARs is crucial for patient safety during allergy diagnosis and treatment.
Purpose of the Study:
- To identify factors associated with systemic allergic reactions during allergen skin testing and immunotherapy.
- To determine the incidence and characteristics of SARs in a large patient cohort.
Main Methods:
- Prospective study conducted from 1976-1989.
- Involved over 10,000 patients and 513,368 allergen injections.
- Data collected on patient demographics, allergen types, dosages, and reaction occurrences.
Main Results:
- SARs incidence: <0.02% for skin testing, 2.9% for immunotherapy.
- Highest incidence in females aged 16-39, particularly during dose escalation.
- Pollen allergens, concentrations (100-1000 PNU/mL), allergen type, dose escalation rate, and patient sensitivity were key factors.
- Prick tests and RAST (Radioallergosorbent Test) aid in risk identification.
Conclusions:
- Allergen immunotherapy carries a higher risk of SARs than skin testing.
- Patient sensitivity, allergen type, and dose escalation rate are critical for managing SAR risk.
- Prick testing is a valuable, cost-effective tool for ruling out SAR risk, especially when combined with RAST.