Embed Size (px)
Citation preview
The 2010 WAO Grading System is a useful tool for accessing SR severity. SR to SCIT with airborne allergens are rare and all of our reacCons were grade 1 or
2. None of the commonly implicated risk factors was idenCfied in our paCents. A large scale study is needed to perform comparaCve analysis and to clarify
the best surveillance and treatment of SR to SCIT.
A first characterizaCon according to WAO's grading system
Santos, Natacha; Pereira, Ana Margarida; Silva, Rui; Torres da Costa, José; Plácido, José Luís Serviço de Imunoalergologia, Centro Hospitalar São João, E.P.E., Porto, Portugal
Systemic reacCons (SR) to subcutaneous immunotherapy (SCIT) are unusual but
potenCally severe.
Poorly controlled asthma, large local reacCons, administraCon during pollen season
and dose error are the more implicated risk factors, but studies have been
hampered due to the variety of previously exisCng classificaCons.
The aim of our study is to characterize SR to SCIT with airborne allergens occurring
in our clinic from January 2008 to June 2010 and to classify them according to the
WAO Subcutaneous Immunotherapy Systemic ReacCon Grading System1.
1L. Cox, D. Larenas-‐Linnemann, R. F. Lockey, G. Passalacqua; Speaking the same language: The World Allergy OrganizaCon Subcutaneous Immunotherapy Systemic ReacCon Grading System; J Allergy Clin Immunol 2010;125:569-‐74. 2J. E. Alvarez-‐Cuesta, J. Bousquet, G. W. Canonica, S. R. Durham, H. J. Malling, E. Valovirta. Standards for pracCcal allergen-‐specific immunotherapy. Ann Allergy Asthma Immunol. Allergy 2006: 61 (Suppl. 82): 1–20
Cross-‐secConal study with data collected from a paCent's
immunotherapy record form. PaCent selecCon and SCIT
administraCon followed EAACI recommendaCons2.
During the study period, 19398 SCIT to airborne allergens
were administered, and immediate reacCons (beginning <
30min), as well as late reacCons, were recorded.
SR occurred in 13 paCents, ♂8:5♀, median age of 25 years-‐
old (6-‐89), in a total of 20 SR (0,1% of all administraCons).
Allergic disease Immunotherapy Systemic reac6ons
Composi6on Formula6on Administra6on Phase Time Manifesta6on WAO
RhiniCs Grass Polymerized Rush InducCon Immediate Rhinorrhea 1z RhiniCs Mites Depot Classical InducCon Immediate Rhinorrhea 1z RhiniCs Mites Depot Classical InducCon Immediate Rhinorrhea 1z
RhiniCs + Asthma Mites Polymerized Classical InducCon InducCon
Late Immediate
Rhinorrhea ConjunCval pruritus
1z 1z
RhiniCs Mites Depot Classical InducCon InducCon InducCon
Late Immediate Late
Rhinorrhea Rhinorrhea Rhinorrhea
1z 1z 1z
RhiniCs Mites Polymerized Classical InducCon Late Oropharingeal pruritus 1z
RhiniCs Mites Polymerized Classical Maintenance Maintenance
Immediate Late
Rhinorrhea Rhinorrhea
1z 1z
RhiniCs + Asthma Grass Polymerized Rush Maintenance Late Sneezing 1z
RhiniCs + Asthma Mites Polymerized Rush InducCon InducCon InducCon
Late Late Late
Asthma Asthma Asthma
2z 2z 2z
RhiniCs + Asthma Mites Polymerized Classical InducCon Late Asthma 2z
RhiniCs + Asthma Mites Polymerized Rush InducCon InducCon
Late Late
Rhinorrhea -‐> Asthma Nasal congesCon
2z 1z
RhiniCs Grass Polymerized Rush InducCon Late Generalized erythema -‐> Wheezing 2z
RhiniCs Mites Polymerized Rush Maintenance Late Generalized erythema -‐> Rhinorrhea -‐> Shortness of breath
2d
There were 14 (70%) late reacCons, with 5 of them occurring aner 3 hours (maximum 48 hours aner). Only 2 paCents had
previous local reacCons, both with wheals < 5cm. All 3 paCents with SCIT to grass had the SR out of the pollen season.
Table 1. CharacterizaCon of paCents and systemic reacCons
