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Modifiable risk factors should be observed for SCIT, SLIT patients

Although the mortality rate for patients undergoing subcutaneous immunotherapy has decreased, researchers still recommend careful selection for patients with modifiable risk factors, according to recent research.

“Subcutaneous immunotherapy-related fatality rates may be decreasing, but continued vigilance regarding modifiable risk factors, including careful patient selection, is needed,” Tolly G. Epstein, MD, MS, from the Division of Immunology, Allergy, and Rheumatology, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, and colleagues wrote in their study. “Dose adjustment during pollen seasons for highly sensitive patients may reduce risks. Potential risk for systemic reactions from off-label sublingual immunotherapy exists.”

Epstein and colleagues reviewed 28.9 million injection visits between 2008 and 2013 reported by members of the American Academy of Allergy, Asthma, and Immunology and the American College of Asthma, Allergy, and Immunology in annual surveys of systemic reactions during sublingual immunotherapy, according to the abstract. The researchers reported systemic reactions through off-label uses of sublingual immunotherapy (SLIT), dose-adjustment strategies through pollen season and selection of patients with asthma for subcutaneous immunotherapy (SCIT).

They found two confirmed patient fatalities while under allergist care and two additional patient fatalities under the care of non-allergists, according to the abstract. Regarding systemic reactions, there was a stable rate of 1.9% for SCIT patients (0.08% grade 3, 0.02% grade 4 SRs) and a 1.4% in patients receiving off-label SLIT (0.03% grade 3). Practices that lowered the dose during pollen season for patients with high positive skin prick tests had reduced systemic reactions of all severities (P < .05). Epstein and colleagues noted there were fewer grade 3 (OR = 0.7; 95% CI, 0.5-1.0) and grade 4 (OR = 0.3; 95% CI, 0.1-0.8) systemic reactions in practices that did not administer SCIT to patients with uncontrolled asthma. – by Jeff Craven

Disclosure: Epstein, Bernstein and Liss received funding from the American Academy of Allergy, Asthma, and Immunology and the American College of Asthma, Allergy, and Immunology.