Systemic Reactions To Aeroallergen Subcutaneous Immunotherapy In A Pediatric Practice
Saturday, March 3, 2018
South Hall A2 (Convention Center)
Megan K. Ford, MD, Roslyn Whitley, MPH, Magee L. DeFelice, MD
RATIONALE: Aeroallergen subcutaneous immunotherapy (SCIT) is effective in allergic rhinoconjunctivitis and asthma treatment. SCIT systemic reactions (SRs) occur approximately 0.2% per injection. Patients with asthma are reported to have a higher SR rate, although most studies evaluated adult populations. The goal of this study is to identify factors that may increase the likelihood of SRs to SCIT in the pediatric population.

METHODS: A retrospective review of all patients on SCIT in a pediatric academic practice from September 1, 2014-July 31, 2017 was performed including demographics, allergic conditions, treatment regimen, and reaction history. Number of injections was collected through billing records.

RESULTS: 133 pediatric patients had a total of 4859 injection visits with 0.6% risk of SR per visit with 1-3 injections per visit. 15.8% of patients developed systemic reactions and 23.8% of those patients experienced repeat SRs. 80.95% of patients with SRs had asthma, compared to 72.37% without SRs (p=0.59). A higher rate of SRs was observed in patients being treated for mold (p=0.0031) and in patients with co-existing food allergy (p=0.0281). The majority of reactions were WAO grade 1 or 2, with no grade 4 or 5. More SRs occurred in spring than other seasons. All patients with SRs without asthma underwent an accelerated build-up schedule.

CONCLUSIONS: SCIT carries a low risk of SRs in children. Mold allergy treatment, co-existing food allergy, accelerated build-up schedules, and spring season may increase the likelihood of SRs. These findings warrant continued investigation of SRs in children to further characterize risk factors and develop SR prevention strategies.