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Allergen immunotherapy adverse reactions: same reaction, different grading

Published online: December 14, 2018

Allergen Immunotherapy (AIT) is the only treatment that can modify the natural course of allergic disease. However, the fear of suffering a systemic adverse reaction during and after the administration of the treatment limits its use. A better understanding of the true severity of these systemic reactions is to improve safety recommendations. In this article from The Journal of Allergy and Clinical Immunology: In Practice, Vidal et al points at the importance of a precise description of reactions due to AIT and how they fit in previously published different international classification systems (from Europe, North America and the World Allergy Organization (WAO)): a comparison that has not been performed until now.

Although AIT has shown a good safety profile in clinical trials, good quality data coming from real life is limited. In order to fill this gap, a prospective, longitudinal safety study was performed for respiratory AIT in clinical practice in three European countries (France, Germany and Spain). A total of 4316 patients were enrolled, and after an average follow up of 13 months, 109 systemic reactions were collected.

All reactions were recorded according to the terminology proposed by MedDRA (a dictionary of medical terms). The elapsed time after the administration of AIT and treatment used to control the reactions were analyzed as well. With all this information, every reaction was re-codified following the criteria proposed in those international classification systems and compared to one another.

Significant disparities in mild or moderate reactions were detected among different classifications. Fortunately, all classifications showed a very good degree of correlation for all severe reactions.  The American classification was the one showing a better correlation with the impression of the doctor who had witnessed the original reaction, and the WAO was the best correlated with the onset of the reaction and the number of organs affected.

Our analysis allows physicians to compare different international classifications of systemic reactions due to AIT to their own severity criteria in daily clinical practice, measuring the specific degree of correlation achieved.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.