Characteristics of Systemic Reactions in the Setting of Modified Environmental Rush Immunotherapy Protocol (MERIT)
Monday, March 7, 2016
South Exhibit Hall H (Convention Center)
Stacy L. Rosenberg, MD, Merritt L. Fajt, MD, Russell Traister, MD PhD, Andrej A. Petrov, MD
Rationale: Conventional allergen immunotherapy is efficacious in allergic rhinoconjunctivitis. However, low adherence has been a significant barrier, whereas rush immunotherapy offers quicker efficacy and may improve adherence.  However, there have been concerns for increased risk of systemic reactions.  We hypothesize that there are specific characteristics that distinguish patients who develop systemic reactions in the setting of modified environmental rush immunotherapy (MERIT).

Methods: We conducted a retrospective analysis of demographic and clinical data from adult patients seen in an outpatient university allergy clinic from January 2005- January 2015 who underwent MERIT.  We specifically focused on patients who underwent MERIT and developed systemic reactions at any time during their allergen immunotherapy.

Results: Preliminary results from evaluation of 22 patients demonstrated no difference in gender (11 male/11 female), with median age of 30.5 years, and median BMI of 24.9.   There was no difference in co-existence of asthma (11 asthmatic/ 11 non-asthmatic).  The most common allergens in the immunotherapy serums were cat (21/22) and dust mite (20/22).  All patients manifested grade I or II WHO reactions, 8/22 had systemic reactions on more than 1 occasion, and the majority of reactions (15/22) occurred during build up phase, after MERIT was completed.   

Conclusions: Our preliminary data suggests that patients undergoing MERIT develop grade I or II systemic reactions during therapy. This does not seem to be associated with gender or asthma history but allergy serum containing dust mite and cat is seen more frequently in those with systemic reactions.  Further comparisons to subjects undergoing MERIT without systemic reactions are underway.