Dose adjustments are unnecessary for local reactions occurring at immunotherapy satellite clinics

Abstract

Rationale Although recent reports have found that a no dose adjustment policy for local reactions does not increase systemic reaction rates, this policy has not been examined in satellite clinics outside of the allergist's office. Methods In 9 satellite clinics from Apr 2002-Jun 2003, a no dose adjustment policy was followed for immediate and late local reactions. During this 15-month period, each suspected systemic reaction following immunotherapy was documented as part of an ongoing quality assurance program. Numbers of injections and systemic reactions were reported quarterly to the allergist prescribing the immunotherapy. Results During this 15-month period, 6,338 immunotherapy injections were administered among the 9 satellite clinics. There were a total of 43 systemic reactions resulting in a 0.68% reaction rate (43/6,338). The historical systemic reaction rate in the office of the prescribing allergist under the same no dose adjustment policy was not statistically different: 0.84% (89/10,636) vs. 0.68% (p=0.26). In addition to existing patients, a total of 84 new immunotherapy prescriptions were written for the satellite clinics during this time period by the single allergist. In general, an immunotherapy maintenance dosage of 0.5 mL 1:100 w/v was used and each maintenance vial consisted of 0.5-1 mL of each antigen. Conclusions A no dose adjustment policy at immunotherapy satellite clinics does not increase systemic reaction rates. Dose adjustments for local reactions are unnecessary and may delay achievement of a therapeutic dose, lead to patient non-compliance due to increased visits, increase costs, and place patients at an increased risk for dose administration errors.