The First Case of Anaphylactic Shock due to Sublingual Immunotherapy with Standardized Mites Allergens

Abstract

IntroductionSublingual immunotherapy (SLIT) is home administration treatment without medical supervision and therefore the safety of this form of immunotherapy is especially important.Case reportA 16-year-old girl, with a history of perennial allergic rhinitis and well-controlled intermittent asthma due to house dust mites began SLIT with standardized extract of HDM (Stallergenes, France). In the 3rd year of SLIT after 3 week break in maintenance dose (10 drops, 100 IR/ml), with unknown reason the girl administered herself 60 drops (100 IR/ml) of allergen extract, equivalent of 26.9 μg of house dust mites allergen. Within 5 minutes generalized pruritus, flushing and generalized urticaria developed, and the girl became dyspneic, began wheezing and shivering followed by double short collapse. Emergency team was called. The doctor found: blood pressure 70/40 mmHg, heart rate 160/min, weak pulse, generalized urticaria, mild asthma symptoms. The girl was sleepy but conscious. Doctor gave methylprednisone i.v., aminophylline i.v., intravenous fluids and oxygen. After several minutes she was admitted to Hospital Emergency Department when she suddenly became unconscious without pulse and blood pressure. She received epinephrine i.m., oxygen, corticosteroids, intravenous fluids and was transferred to Intensive Care Unit, where she recovered during one day.ConclusionsThe case leads to reconfirm the safety of sublingual immunotherapy schedule with large dose of allergen without up-dosing phase and expands the education and monitoring field of SLIT patients. IntroductionSublingual immunotherapy (SLIT) is home administration treatment without medical supervision and therefore the safety of this form of immunotherapy is especially important. Sublingual immunotherapy (SLIT) is home administration treatment without medical supervision and therefore the safety of this form of immunotherapy is especially important. Case reportA 16-year-old girl, with a history of perennial allergic rhinitis and well-controlled intermittent asthma due to house dust mites began SLIT with standardized extract of HDM (Stallergenes, France). In the 3rd year of SLIT after 3 week break in maintenance dose (10 drops, 100 IR/ml), with unknown reason the girl administered herself 60 drops (100 IR/ml) of allergen extract, equivalent of 26.9 μg of house dust mites allergen. Within 5 minutes generalized pruritus, flushing and generalized urticaria developed, and the girl became dyspneic, began wheezing and shivering followed by double short collapse. Emergency team was called. The doctor found: blood pressure 70/40 mmHg, heart rate 160/min, weak pulse, generalized urticaria, mild asthma symptoms. The girl was sleepy but conscious. Doctor gave methylprednisone i.v., aminophylline i.v., intravenous fluids and oxygen. After several minutes she was admitted to Hospital Emergency Department when she suddenly became unconscious without pulse and blood pressure. She received epinephrine i.m., oxygen, corticosteroids, intravenous fluids and was transferred to Intensive Care Unit, where she recovered during one day. A 16-year-old girl, with a history of perennial allergic rhinitis and well-controlled intermittent asthma due to house dust mites began SLIT with standardized extract of HDM (Stallergenes, France). In the 3rd year of SLIT after 3 week break in maintenance dose (10 drops, 100 IR/ml), with unknown reason the girl administered herself 60 drops (100 IR/ml) of allergen extract, equivalent of 26.9 μg of house dust mites allergen. Within 5 minutes generalized pruritus, flushing and generalized urticaria developed, and the girl became dyspneic, began wheezing and shivering followed by double short collapse. Emergency team was called. The doctor found: blood pressure 70/40 mmHg, heart rate 160/min, weak pulse, generalized urticaria, mild asthma symptoms. The girl was sleepy but conscious. Doctor gave methylprednisone i.v., aminophylline i.v., intravenous fluids and oxygen. After several minutes she was admitted to Hospital Emergency Department when she suddenly became unconscious without pulse and blood pressure. She received epinephrine i.m., oxygen, corticosteroids, intravenous fluids and was transferred to Intensive Care Unit, where she recovered during one day. ConclusionsThe case leads to reconfirm the safety of sublingual immunotherapy schedule with large dose of allergen without up-dosing phase and expands the education and monitoring field of SLIT patients. The case leads to reconfirm the safety of sublingual immunotherapy schedule with large dose of allergen without up-dosing phase and expands the education and monitoring field of SLIT patients.