ADVERSE EFFECTS OF ALLERGEN IMMUNOTHERAPY: Assessment and Treatment

Abstract

1. No allergenic vaccine should be considered completely safe for an individual allergic to its contents. 2. Physicians who prescribe allergen immunotherapy should administer injections in an office or clinic that has appropriate medical equipment and personnel trained to recognize and treat a systemic reaction promptly and efficiently if one occurs. 3. The risk of a fatal systemic reaction may be reduced by careful selection and monitoring of individuals placed on immunotherapy, the use of standardized allergen vaccines, the use of conventional administration schedules, and the prompt recognition and treatment of systemic reactions. 4. Injectable epinephrine is the treatment of choice for systemic reactions and all subsequent therapeutic measures depend on the initial response to epinephrine. 5. A 20-minute waiting period after an immunotherapy injection is generally adequate, but the period should be extended for patients considered high risks for systemic reactions. 6. Fatalities associated with allergen immunotherapy are rare with an estimated incidence of 1 per 2 million injections. 7. Individuals at greatest risk for a systemic reaction to immunotherapy are those with asthma, particularly poorly controlled asthma. 8. Other significant risk factors for anaphylaxis due to immunotherapy include accelerated (“rush”) immunotherapy regimens, concurrent use of β-blocker medications, a seasonal exacerbation of asthma or rhinitis, and a high degree of allergic hypersensitivity. 9. More placebo-controlled studies are necessary to clarify the therapeutic role of local immunotherapy. While other modes of delivery may be effective and produce fewer side effects than injection immunotherapy, bronchial immunotherapy has produced bronchospasm in most patients.