SELECTED ARTICLES FROM THE RECENT LITERATURE 2008

9/22/2008

Frequency of systemic reactions with sublingual immunotherapy

Summary
The authors of this investigation performed a prospective, open-label, single arm study of sublingual immunotherapy. Subjects ranged in age from 6 to 50 years. Each had at least a two year history of significant allergic rhinoconjunctivitis and/or mild to moderate asthma, and demonstrated sensitivity to at least one aeroallergen on prick testing.

They employed commercial extracts standardized in either equivalent biological units per milliliter or specific protein units per milliliter. Patients were treated with house dust mite, pollen, or cockroach preparations depending upon the individual sensitizations.

A 90-day dose progressive protocol was utilized. Five ml vials of allergen diluted with physiologic saline in progressive concentrations of 1.13 U/ml to 142 U/ml through vial four were employed. Vial five contained 710 U/ml with 50% volume/volume of glycerol and 0.4% WT/volume of phenol. Each vial contained only one extract.

The extracts were delivered by individual dispensers and separated by a minimum of 120 minutes. If more than one extract was administered and the patient was receiving Dermatophagoides, the patient was instructed to use the Dermatophagoides vial first.

According to the schedule, by the end of the buildup phase, a cumulative dose of 729.82 U was reached. Forty-three patients with a median age of 11 years were included.They were sensitized mostly to Dermatophagoides pteronyssinus and Dermatophagoides farinae.

Four patients (9%) experienced an immediate and one (2%) experienced a late systemic reaction. In total, there were seven systemic reactions. All reactions were associated with wheezing or worsening nasal symptoms. In addition, one patient had angioedema and urticaria.

The authors concluded that the reaction rate was 11.6%, and all reactions were classified as grade 2 or 3. They were graded according to the European Academy of Allergy and Clinical Immunology Immunotherapy Position Paper (1).

(1) J Allergy Clin Immunol 1997; 100:458-463.

Reference
Rodriguez-Perez, et al. Frequency of acute systemic reactions in patients with allergic rhinitis and asthma treated with sublingual immunotherapy. Annals of Allergy, Asthma and Immunology 2008; 101:304-310.

 

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