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J Allergy Clin Immunol Pract. 2018 Sep - Oct;6(5):1711-1716.e4. doi: 10.1016/j.jaip.2017.11.040. Epub 2018 Jan 12.

Systemic Reactions in Pediatric Patients Receiving Standardized Allergen Subcutaneous Immunotherapy with and without Seasonal Dose Adjustment.

Author information

1
Division of Immunology, Boston Children's Hospital, Department of Pediatrics Harvard Medical School, Boston, Mass.
2
Department of Pharmacy, Boston Children's Hospital, Boston, Mass.
3
Institutional Centers for Clinical and Translational Research, Clinical Research Center, Boston Children's Hospital, Boston, Mass.
4
Division of Immunology, Boston Children's Hospital, Department of Pediatrics Harvard Medical School, Boston, Mass. Electronic address: rima.rachid@childrens.harvard.edu.

Abstract

BACKGROUND:

The 2003 Joint Task Force on Practice Parameters recommended standardizing allergen subcutaneous immunotherapy (SCIT). Data from longitudinal surveillance survey in North America reported a systemic reaction (SR) rate of 0.1% to 0.2% of injection visits. The rate of SR to standardized SCIT in pediatric patients has not been well evaluated.

OBJECTIVE:

The objective of this study was to evaluate the rate of SRs to standardized SCIT in pediatric patients aged 5 to 18 years in a single tertiary care center in the United States.

METHODS:

A retrospective chart review was conducted in 2 groups: group 1 started SCIT within a period extending from January 2009 to June 2012, whereas group 2 started SCIT within a period extending from January 2013 to June 2016. The protocol was modified in group 2 such that updosing and maintenance doses were adjusted in the spring for tree and grass pollen and in the fall for weed pollen.

RESULTS:

There were a total of 128 patients in group 1 and 118 patients in group 2. The rate of SR was 0.429% in group 1 and 0.364% in group 2, which was not significant. There was no difference in the severity of SR in the 2 groups with no-fatal or near-fatal SR noted. Asthma was a significant risk factor in the younger age subgroup aged 5 to 11 years.

CONCLUSIONS:

Standardized SCIT appears to be associated with an SR rate of 0.429% to 0.364% of visits in pediatric patients. Protocol modification did not lead to a significant drop in SR. Larger multicenter studies are required to further evaluate the rate of SRs from standardized SCIT.

KEYWORDS:

Children; Pediatric; Safety; Subcutaneous immunotherapy; Systemic reaction

PMID:
29339129
DOI:
10.1016/j.jaip.2017.11.040

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