. 2021 Jul 6;17(1):65.

doi: 10.1186/s13223-021-00566-x.

Systemic reactions to subcutaneous allergen immunotherapy: real-world cause and effect modelling

Adam Aue¹, Joella Ho², Rongbo Zhu³, Harold Kim^{3

4}, Samira Jeimy^{5

6}

Affiliations

¹ Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
² Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
³ Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada.
⁴ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁵ Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada. Samira.Jeimy@lhsc.on.ca.
⁶ St. Joseph's Healthcare London, B3-112, 268 Grosvenor Street, London, ON, N6A 4V2, Canada. Samira.Jeimy@lhsc.on.ca.

PMID: 34229743
PMCID: PMC8262003
DOI: 10.1186/s13223-021-00566-x

Systemic reactions to subcutaneous allergen immunotherapy: real-world cause and effect modelling

Adam Aue et al. Allergy Asthma Clin Immunol. 2021.

. 2021 Jul 6;17(1):65.

doi: 10.1186/s13223-021-00566-x.

Authors

Adam Aue¹, Joella Ho², Rongbo Zhu³, Harold Kim^{3

4}, Samira Jeimy^{5

6}

Affiliations

¹ Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
² Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
³ Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada.
⁴ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁵ Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON, Canada. Samira.Jeimy@lhsc.on.ca.
⁶ St. Joseph's Healthcare London, B3-112, 268 Grosvenor Street, London, ON, N6A 4V2, Canada. Samira.Jeimy@lhsc.on.ca.

PMID: 34229743
PMCID: PMC8262003
DOI: 10.1186/s13223-021-00566-x

Abstract

Background: Subcutaneous immunotherapy (SCIT) is an effective treatment for allergic rhinoconjunctivitis. However, adverse events, including life-threatening systemic reactions, may occur. The purpose of this project is to identify risk factors for systemic reactions to SCIT and to provide practice-based solutions using a quality improvement (QI) framework.

Methods: A QI initiative was performed in a hospital-based, Canadian Allergy clinic administering SCIT in a 12-month period.

Results: A total of 4242 injections of SCIT were performed over a period of 12 months. Of these, 10 injections resulted in a systemic reaction requiring epinephrine administration (i.e., an incidence of 1 in 424 injections, or 0.24%). Eight patients had at least one documented risk factor for a systemic reaction, and six had multiple risk factors. Major risk factors included seasonal exacerbation of allergic rhinitis, uncontrolled asthma, and an error in route of administration. All reactions occurred with the highest allergen extract concentration.

Conclusion: This QI initiative highlights the need for improved patient and health care practitioner education and pre-administration screening. We suggest several considerations for SCIT administration: provide patients with written information on safety; screen patients before injections, including a review of treatment plan adherence and asthma control; adjust dosing to slow down buildup of the most concentrated immunotherapy extract, particularly in high risk patients; and apply additional safety measures in patients with multiple risk factors.

Keywords: Aeroallergen; Allergy; Anaphylaxis; Immunotherapy; Quality improvement; Subcutaneous immunotherapy; Systemic reaction.

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Conflict of interest statement

Adam Aue, Joella Ho, and Rongbo Zhu have no conflicts of interest to disclose. Harold Kim has been on the speakers bureau and/or advisory boards for ALK, Aralez, AstraZeneca, GSK, Kaleo, Mylan, Pediapharm, Pfizer, and Stallergenes Greer. Samira Jeimy has been on speakers bureaus for Aralez, Novartis, AstraZeneca, and Sanofi, and on the national advisory board for Sanofi.

Figures

**Fig. 1**
Systemic Reaction Quality Improvement Diagram. Analysis of factors which may be targeted to reduce the risk of systemic reactions. These identified factors can be divided into four categories: patient, nurse, clinic, and physician

See this image and copyright information in PMC

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Systemic reactions to subcutaneous allergen immunotherapy: real-world cause and effect modelling

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Systemic reactions to subcutaneous allergen immunotherapy: real-world cause and effect modelling

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