ÖZGE YILMAZ, Hasan YÜKSEL, Ahmet TÜRKELİ, Ezgi YANGIN ERGON, Esra TOPRAK KANIK

Safety of subcutaneous allergen immunotherapy in children: A retrospective review and bird eye to literature

Subcutaneous allergen immunotherapy (SCIT) has been shown to improveclinical course in children with asthma and allergic rhinitis (AR). Systemicand local side-effects may be seen during its administration. The purposeof this study was to evaluate risk factors associated with systemic and localside-effects in children receiving SCIT. We performed a retrospective chartreview in the children who received allergen subcutaneous immunotherapyfor asthma and/or allergen rhinitis. Demographic data, diagnosis, skin pricktest results, presence of additional allergic diseases, the seasonal variationof adverse events in the first and third years of SCIT were recorded. Atotal of 508 eligible patients were included in the study. Mean age of thechildren was 10.9±3.2 years, and 65.4% were male. Asthma was presentin 21.9% of the children, AR in 44.7%, 33.5% of them had both asthmaand AR. According to the skin prick test results, sensitivity to more thanone allergen was present in 45.1%, while the most common single-allergensensitivities were to grass pollen and dermatophagoids (32.5% and 14.4%,respectively). Ratio of systemic and local side-effects was 4.7% and 9.3%,respectively. Local side-effects were more common than systemic reaction.SCIT is a safe treatment modality while using the appropriate dose and withthe administration of dose-escalation protocol.

PDF

___

Akdis CA, Akdis M. Mechanisms of allergen-specific immunotherapy. J Allergy Clin Immunol 2011; 127: 18-27.
Burks AW, Calderon MA, Casale T, et al. Update on allergy immunotherapy: American Academy of Allergy, Asthma and Immunology/European Academy of Allergy and Clinical Immunology/PRACTALL consensus report. J Allergy Clin Immunol 2013; 131: 1288-1296.e3.
Moote W, Kim H. Allergen-specific immunotherapy. Allergy Asthma Clin Immunol 2011; 7(Suppl 1): S5.
Jacobsen L, Wahn U, Bilo MB. Allergen-specific immunotherapy provides immediate, long-term and preventive clinical effects in children and adults: The effects of immunotherapy can be categorised by level of benefit -the centenary of allergen specific subcutaneous immunotherapy. Clin Transl Allergy 2012; 2: 8.
Aryan Z, Comapalati E, Canonica GW, Rezaei N. Allergen-specific immunotherapy in asthmatic children: From the basis to clinical applications. Expert Rev Vaccines 2013; 12; 639-659.
Malling H, Weeke. Position paper: Immunotherapy (EAACI) The European Academy of Allergology and Clinical Immunology. Allergy 1993; 48(14 Suppl): 7-35.
Calderon MA, Gerth van Wijk R, Eichler I, et al.; European Academy of Allergy and Clinical Immunology. Perspectives on allergen-specific immunotherapy in childhood: An EAACI position statement. Pediatr Allergy Immunol 2012; 23: 300-306.
Sahiner UM, Civelek E, Yavuz ST, Buyuktiryaki AB, Tuncer A, Sekerel BE. Skin prick testing to aeroallergen extracts: What is the optimal panel in children and adolescents in Turkey? Int Arch Allergy Immunol 2012; 157: 391-398.
Heinzerling L, Frew AJ, Bindslev-Jensen C, et al. Standard skin prick testing and sensitization to inhalant allergens across Europe--a survey from the GALEN network. Allergy 2005; 60: 1287-1300.
Madsen F. EAACI ‘Standards for practical allergenspecific immunotherapy’. Allergy 2007; 6: 332.
Ramirez NC, Ledford DK. Immunotherapy for allergic asthma. Med Clin North Am 2002; 86: 1091-1112.
Winther L, Arnved HJ, Malling HJ, Nolte H, Mosbech H. Side-effects of allergen-specific immunotherapy. A prospective multi-centre study. Clin Exp Allergy 2006; 36: 254-260.
Mosbech H, Müller U. Side-effects of insect venom immunotherapy: Results from an EAACI multicenter study. European Academy of Allergology and Clinical Immunology. Allergy 2000; 55: 1005-1010.
Ebstein TG, Liss GM, Murphy-Berendts K, Bernstein DI. Immediate and delayed onset-systemic reactions after subcutaneous immunotherapy injections: ACAAI/ AAAAI surveillance study of subcutaneous immunotherapy: year 2. Ann Allergy Asthma Immunol 2011; 107: 426-431.e1.
Dursun AB, Sin BA, Oner F, Misirligil Z. The safety of allergen immunotherapy (IT) in Turkey. J Investig Allergol Clin Immunol 2006; 16: 123-128.
Klimek L, Schendzielorz P, Pinol R, Pfaar O. Specific subcutaneous immunotherapy with recombinant grass polen allergens: First randomized dose-ranging safety study. Clin Exp Allergy 2012; 42: 936-945.
Bahceci Erdem S, Nacaroglu HT, Karaman S, et al. Risk of systemic allergic reactions to allergen immunotherapy in a pediatric allergy clinic in Turkey. Int J Pediatr Otorhinolaryngol 2016; 84: 55-60.
Kannan JA, Epstein TG. Immunotherapy safety: What have we learned from surveillance surveys? Curr Allergy Asthma Rep 2013; 13: 381-388.
Makatsori M, Calderon MA. Anaphylaxis: Still a ghost behind allergen immunotherapy. Curr Opin Allergy Clin Immunol 2014; 14: 316-322.
Amin HS, Liss GM, Bernstein DI. Evaluation of nearfatal reactions to allergen immunotherapy injections. J Allergy Clin Immunol 2006; 117: 169-175.
Saltoun CA. Update on efficacy of allergen immunotherapy for allergic rhinitis and asthma. Allergy Asthma Proc 2002; 23: 377-380.
Bernstein DI, Epstein T. Systemic reactions to subcutaneous allergen immunotherapy. Immunol Allergy Clin North Am 2011; 31: 241-249.
Moreno C, Cuesta-Herranz J, Fernandez-Tavora L, Alvarez-Cuesta E; Immunotherapy Committee, Sociedad Española de Alergología e Inmunología Clínica. Immunotherapy safety: A prospective multicentric monitoring study of biologically standardized therapeutic vaccines for allergic diseases. Clin Exp Allergy 2004; 34: 527-531.
Winther L, Malling HJ, Mosbech H. Allergen-specific immunotherapy in birch- and grass-pollen-allergic rhinitis. II. Side-effects. Allergy 2000; 55: 827-835.
Ebstein TG, Liss GM, Murpy-Brendts K, Bernstein DI. AAAAI and ACAAI surveillance study of subcutaneous allergen immunotherapy, year 3: what practices modify the risk of systemic reactions? Ann Allergy Asthma Immunol 2013; 110: 274-278.
Cox L, Larenas-Linnemann D, Lockey RF, Passalacqua G. Speaking the same language: The World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System. J Allergy Clin Immunol 2010; 125: 569-574.
Rottem M, Egbarya A. Subcutaneous immunotherapy in Northern Israel: Efficacy and safety. Isr Med Assoc J 2014; 16: 539-543.
Iglesias-Cadarso A, Hernández-Weigand P. Risk factors for systemic reactions to allergen immunotherapy. Curr Opin Allergy Clin Imunol 2011; 11: 579-585.
Schaffer FM, Naples AR, Ebeling M, Hulsey TC, Garner LM. The safety of self-administered allergen immunotherapy during the buildup and maintenance phases. Int Forum Allergy Rhinol 2015; 5: 149-156.