Subcutaneous Immunotherapy Research Articles

Local and Systemic Reactions due to Subcutaneous Allergen Immunotherapy: Our Single-Center 5-Year Experience

Aim: Subcutaneous allergen immunotherapy (SCIT) currently represents the only disease-modifying therapeutic option for the treatment of allergic rhinitis/conjunctivitis, asthma, and venom sensitization. Although SCIT represents a fairly safe therapeutic option in the hands of experienced physicians and centers, it may also be associated with certain adverse effects. In this study, we describe the local and systemic adverse effects in our adult patients undergoing immunotherapy over a 5-year period in an effort to define the causative factors. Materials and Methods: A total of 4413 injections administered to 119 patients (58 female, 61 male) were analyzed. Results: A total of 119 patients with a mean age of 33.7 ± 12 years were included (Female: 58, 48%; Male: 61, 51.3%). In the total population of 119 patients, 6 (5%) developed local reactions, 21 (17.7%) developed large local reactions, and 9 (7.6%) had systemic reactions. Of all injections administered throughout the study period, 0.14% were associated with local reactions, 0.48% with large local reactions, and 0.20% with systemic reactions. Four patients with systemic reactions (44.4%) required epinephrine injection. Patients who did or did not develop adverse effects were significantly different with regard to IgE levels and eosinophil counts (p=0.001 and p=0.002). There was a significant difference between the rates of total adverse reactions developing during the build-up or maintenance phase (p=0.025). Conclusion: Clinicians’ awareness regarding the local, large local, and systemic reactions associated with SCIT should be improved, and clinicians should be more careful during the immunotherapy, especially in the build-up phase, for adverse events.

Maintained disease control and steroid-sparing effect of subcutaneous immunotherapy in allergic rhinitis and asthma.

Allergen immunotherapy is the only currently available treatment strategy that modifies the immune response to the causative allergen and induces clinical improvement and a steroid-sparing effect. In this real-life study, we aimed to evaluate and compare the efficacy of subcutaneous immunotherapy (SCIT) with one allergen or multiple allergens in children and adults with asthma and/or allergic rhinitis in terms of disease control and a steroid-sparing effect. Demographics, the initial inhaled corticosteroid (ICS) and/or intranasal corticosteroid (INS) dose, and other drugs of patients receiving SCIT for at least 12 months were recorded. Data on the final dose/use of ICS/INS and asthma and/or allergic rhinitis control were gathered. Of 104 patients included, 57.1% and 64.5% of patients with asthma and allergic rhinitis, respectively, were able to discontinue ICS and INS after SCIT. The median time to INS and ICS dose reduction was 6 months. SCIT with one allergen or multiple allergens effectively reduced the ICS and INS dose and led to control of asthma and allergic rhinitis, with no significant difference between the groups. When the efficacy of SCIT was compared in children and adults, there was no significant difference in terms of a steroid-sparing effect or the control of asthma and allergic rhinitis. SCIT was effective in both children and adult patients. In this real-life observational study, we have demonstrated a marked steroid-sparing effect while maintaining control of asthma and allergic rhinitis in children and adults treated with one allergen or multiple allergens.

Effectiveness of House Dust-mite Subcutaneous Allergen Immunotherapy (HDM-SCIT) Combined with Omalizumab (Anti-IgE) in Five Cases of Steroid-Dependent Allergic Rhinitis with Asthma

Effectiveness of House Dust-mite Subcutaneous Allergen Immunotherapy (HDM-SCIT) Combined with Omalizumab (Anti-IgE) in Five Cases of Steroid-Dependent Allergic Rhinitis with Asthma

ICS/LABA Combined With Subcutaneous Immunotherapy Modulates the Th17/Treg Imbalance in Asthmatic Children.

RationaleThe imbalance of T helper (Th17) cell and regulatory T (Treg) cell are involved in allergic asthma pathogenesis. We hypothesized that ICS/LABA could modulate the Th17/Treg imbalance and that subcutaneous immunotherapy (SCIT) could coordinate with ICS/LABA to rebalance the dysfunction of Th17/Treg.MethodsThirty house dust mites (HDM) allergic asthmatic children and fifteen healthy control subjects were enrolled in this study. Fifteen asthmatic children were treated by ICS/LABA powder inhalation, while the other fifteen asthmatic children were treated by ICS/LABA powder inhalation combined with HDM-SCIT. Asthmatic subjects were followed up for 6 months, but 2 asthmatics treated with ICS/LABA were lost to follow-up. Flow cytometry was used to determine the proportions of Th17 and Treg in CD4+ T cells from peripheral blood mononuclear cells (PBMCs). Serum levels of IL-17A and IL-10 were assessed by ELISA.ResultICS/LABA treatment significantly reduced the percentage of Th17 cells (1.252 ± 0.134% vs. 2.567 ± 0.386%), serum IL-17A (49.42 ± 2.643 pg/ml vs. 66.75 ± 3.442 pg/ml) and Th17/Treg ratio (0.194 ± 0.025 vs. 0.439 ± 0.072) compared to baseline (P<0.01). The ICS/LABA+HDM-SCIT treatment group showed similar reduction in the percentage of Th17 cells (1.11 ± 0.114% vs. 2.654 ± 0.276%), serum IL-17A (49.23 ± 2.131 pg/ml vs. 66.41 ± 2.616 pg/ml) and the Th17/Treg ratio (0.133 ± 0.015 vs. 0.4193 ± 0.050) (P<0.01). ICS/LABA+HDM-SCIT treatment group demonstrated elevated Treg percentages (8.483 ± 0.408% vs. 6.549 ± 0.299%) and serum IL-10 levels (127.4 ± 4.423 pg/ml vs. 93.15 ± 4.046 pg/ml), resulting in a lower Th17/Treg ratio than the ICS/LABA group.ConclusionICS/LABA treatment regulates Th17/Treg imbalance mainly by mitigating Th17-induced inflammation in asthma patients. The addition of SCIT further enhanced such effect by upregulating Treg cells.

Clinical and Laboratory Profile of Patients with Anaphylaxis To Fire Ant Venom (Solenopsis sp.) Under Subcutaneous Immunotherapy

Clinical and Laboratory Profile of Patients with Anaphylaxis To Fire Ant Venom (Solenopsis sp.) Under Subcutaneous Immunotherapy

Sustained impact of subcutaneous immunotherapy among patients with allergic rhinitis who experienced treatment delay due to the COVID-19 pandemic: A multicenter, two-arm, real-world study.

Sustained impact of subcutaneous immunotherapy among patients with allergic rhinitis who experienced treatment delay due to the COVID-19 pandemic: A multicenter, two-arm, real-world study.

Ultrarush immunotherapy with polymerized extracts during the coronavirus disease 2019 pandemic: Safety of restarting administrations without dose adjustments

Allergen-specific immunotherapy (AIT) is the only therapy that can change the natural history of allergic diseases and it has been established as an effective treatment in immediate-type allergic reactions and associated diseases such as asthma and rhinoconjunctivitis. This applies to both subcutaneous immunotherapy (SCIT) and sublingual immunotherapy. The SCIT is safe and mostly well tolerated. However, patients are required to attend a medical facility with trained staff and proper equipment to manage potential reactions.

Alternatives to Subcutaneous Immunotherapy for Allergic Rhinitis

Allergic rhinitis (AR) is an important public health issue worldwide due to its increasing prevalence and impact on quality of life, school performance, and work productivity. Subcutaneous immunotherapy (SCIT) is used to treat AR and involves repeated injections of allergen extracts. SCIT is used for cases of severe AR with symptoms that are not adequately controlled by medication, when the side effects of medication limit treatment options, or where the aim is to cure rather than symptomatically treat. Although SCIT is effective, it is not necessarily curative. Furthermore, there is also a low but present risk of systemic allergic reactions, with systemic side effects occurring in less than 0–1% of treated patients. Sublingual immunotherapy (SLIT) has emerged as an effective and safe alternative to SCIT. SCIT and SLIT are the only immunotherapies currently available for AR. In addition to sublingual administration as an alternative to SCIT, other routes of antigen administration have been attempted with the goal of increasing safety while maintaining efficacy. This review discusses the efficacies of SCIT and SLIT, their mechanisms, the utility of intralymphatic immunotherapy (ILIT) as an alternative route of antigen administration, and the potential for immunotherapy using other routes of antigen administration.

MiRNAprofiles changeduring grass pollen immunotherapy irrespective of clinical outcome.

Background: Subcutaneous immunotherapy (SCIT) is widely used in the treatment of allergic rhinitis (AR). This study aimed to determine the expression of 48 miRNAs in patients with AR undergoing grass pollen SCIT and investigate relations with clinical outcomes. Methodology: Expression of selected miRNAs was determined using RT-PCR in thefull blood of 16 patients with AR and sevenhealthy controls. Results:miR-136, miR-208 and miR-190 were upregulated in theAR group. After 6 months of SCIT, significant downregulation of some proinflammatory miRNAs and upregulation of several miRNAs regulating Th1/Th2 balancewerefound. No differences were found between good and poor responders. Conclusion:miRNAs may play a regulatory role in SCIT, leading to tolerance induction.

Clinical and laboratory profiles of pediatric asthma patients with house dust mite (HDM)–specific subcutaneous immunotherapy: A single center, cross sectional study

Introduction: House dust mite (HDM) allergy has been reported as an actual cause of asthma in children. Subcutaneous immunotherapy (SCIT) is a recommended treatment for HDM allergy patients. However, there were limited data about the characteristic of pediatric patients with HDM-SCIT, particularly in Indonesia. This study was aimed to evaluate the characteristic of pediatric patients with allergic asthma.&#x0D; Methods: Study participants were pediatric patients confirmed with HDM allergy from Skin Prick Test (SPT) in the pediatric allergy-immunology outpatient clinic in Saiful Anwar Hospital Malang, Indonesia. Patients who were treated with HDM-SCIT in the early build-up phase of treatment were included in this study. Demographic and clinical characteristics of the patients were recorded. Peripheral blood samples were drawn to evaluate the total eosinophil count (TEC), total basophil count (TBC), neutrophil-lymphocyte ratio (NLR), specific IgE (sIgE) and total IgE (t-IgE) level. Clinical diagnosis of asthma was classified according to the Global Initiative for Asthma (GINA) criteria. The evaluation of asthma control was assessed by the Asthma Control Test (ACT) score. &#x0D; Results: Thirty-two patients were enrolled in this study, including 14 male and 18 female. The mean age of children was 6.92 ± 2.60 years old. There were 21 subjects with uncontrolled asthma and 11 subjects with partially controlled asthma. Demographic characteristics including age, sex, nutritional status and family history were not significantly different between uncontrolled and partially controlled asthma groups (p&gt; 0.05). TEC, TBC, NLR, and tIgE were not different significantly among groups (p&gt; 0.05). This study showed that the mean of sIgE serum level was higher in uncontrolled asthma compared to partially controlled asthma group (p= 0.022). Moreover, it was a negative significant correlation between sIgE serum level and ACT score (p= 0.002, r= -0.532). &#x0D; Conclusion: Higher sIgE levels were correlated with poor asthma control in HDM-SCIT patients.

Immunotherapy Effectiveness in Treating Peanut Hypersensitivity: A Systemic Review.

Peanut hypersensitivity is one of the top causes of food-related allergic responses and death in high-income countries. As a result, the goal of this study was to see if various forms of immunotherapies can help reduce the severity of peanut hypersensitivity reactions.From 2019 to 2021, a systematic search of PubMed, Web of Science, Wiley online library, and Science Direct was done. Peanut immunotherapy (PIT) clinical trials were considered. There were 19 trials with a total of 1565 participants. Twelve were on oral immunotherapy (OIT), two on sublingual immunotherapy (SLIT), two on subcutaneous immunotherapy (SCIT), two on epicutaneous immunotherapy (EPIT), and one was a comparison of SLIT and OIT.Desensitization was achieved by 74.3% of those who received OIT, 11% of those who received SLIT, 61% of those who received SCIT, and 49% of those who received EPIT. The majority of adverse events (AE) were mild to moderate. Those requiring epinephrine, on the other hand, were moderate to severe and were more common in the therapy groups.This systematic review showed that the current PIT regimens can accomplish desensitization regardless of the route of administration, with an acceptable safety profile.

Subcutaneous immunotherapy with aeroallergens: safety profile assessment.

Introduction. Severe systemic reactions (SR) to allergen subcutaneous immunotherapy (SCIT) are rare but local reactions (LR) are common. We aimed to characterize the type of reactions and safety profile. Methods. Retrospective analysis of medical record from patients under SCIT between 2013-2016. Results. Total of 7372 SCIT injections in 323 patients: 52% female; mean age 30 years (SD 13); mean treatment time 19 months (SD 13). There were 57 patients (17.6% of population, 70% female) with at least one adverse reaction, for 93 reactions described (1.3% injections). There were 79 LR (1.1% injections) in 46(14.2%) patients: 36 in build-up, 43 in maintenance. There were 14 SR (0.19% injections) in 12(3.7%) patients: 12 in build-up, 2 in maintenance. All SR were grade 1. The majority of reactions were caused by mite SCIT (69.9%). Conclusions. SCIT is safe and well tolerated, with no report of SR grade > 1.

Sustained benefit of a 3-year cycle of subcutaneous house dust mite immunotherapy in local allergic rhinitis individuals

Subcutaneous allergen immunotherapy (SCIT) decreases allergic and local allergic rhinitis (AR and LAR, respectively) symptoms. In AR patients also induces a sustained effect lasting several years after therapy withdrawal. Whether SCIT has a comparable long-lasting effect in LAR is currently unknown. We evaluated the long-term evolution of LAR patients with a 3-year SCIT treatment with Dermatopagoidespteronyssinus (DP) (DP-SCIT), as compared to AR subjects.

Induction of Allergen-Neutralizing IgG4 and IgA Blocking Antibodies Following Subcutaneous Immunotherapy with Mannan-Conjugated Birch Pollen Allergoid

Birch pollen SCIT using allergoid-mannan conjugate is a novel therapeutic approach that targets C-type lectin receptors on dendritic cells to induce tolerance. We hypothesized that SCIT with this conjugate induces allergen-specific IgA1, IgA2 and IgG4 and that the induction of these antibodies correlates with the binding of allergen-IgE complexes to CD23 on B cells.

Preference for sublingual immunotherapy with tablets in a Spanish population with allergic rhinitis.

BackgroundThis study investigated patients' preference for allergy immunotherapy (AIT) administered as either sublingual immunotherapy‐tablets versus monthly or weekly subcutaneous immunotherapy (SCIT) from a Spanish patient perspective.MethodsA discrete choice experiment (DCE) consisting of two blocks with eight choice sets in each was constructed to elicit the preferences for AIT. Three attributes were included in the DCE for the mode of administration, including the frequency of administration, the risk of systemic reactions and the co‐payment. Adults and caregivers of children with moderate to severe allergic rhinitis (AR) were included if they were not currently receiving or had not previously received AIT.ResultsIn total, 587 adults and 613 caregivers started the survey. Of those, 579 adults and 611 caregivers completed the survey and were included in the study. Both adults and caregivers had a significant preference for tablets compared with both monthly and weekly injections (p ≤ 0.0001). Furthermore, the respondents showed a significant preference for reducing the risk of systemic reactions. Subgroup analyses showed that caregivers of polyallergic children and female caregivers were significantly less price sensitive when choosing their preferred treatment.ConclusionOur study demonstrated that both adults with AR and caregivers of children with AR prefer daily SLIT‐tablets to SCIT with either a weekly or monthly dose schedule.

Clinical Trial Experience With a New Pollen Sampling Network In The US

A pollen sampling network was developed in the United States (US) to support an exploratory field study using a modified grass allergen subcutaneous immunotherapy (SCIT) product with MicroCrystalline Tyrosine (MCT) and Monophosphoryl Lipid A (MPL) as adjuvant system for allergic rhinoconjunctivitis.

Three Allergens Subcutaneous Inmunotherapy In Polen-Allergic Patients: Our Experience

Allergen immunotherapy is the only disease-modifying treatment for allergic asthma and allergic rhinoconjunctivitis (RC). The objective of this study was to describe our experience in patients under treatment with three allergens subcutaneous immunotherapy (SCIT).

Baseline Conjunctival Provocation Testing Score Predicts Grass-Specific Immunoglobulin Response

A baseline conjunctival provocation test (CPT) score was optimized to predict which subjects with grass pollen induced seasonal allergic rhinitis/rhinoconjunctivitis would benefit most from treatment with a modified grass allergen subcutaneous immunotherapy (SCIT) product using MicroCrystalline Tyrosine and Monophosphoryl Lipid A as adjuvant system. A corresponding predictive treatment effect of the Immunoglobulin (Ig)G4 response would further strengthen these findings.

A Tyrosine Adsorbed Modified Grass Allergen + MPL SCIT Demonstrates Clinically Improvement in Combined Symptom and Medication Score in Subjects with Seasonal Allergic Rhinitis and/or Rhinoconjunctivitis

An exploratory field study with a modified grass allergen subcutaneous immunotherapy (SCIT) product using MicroCrystalline Tyrosine (MCT) and Monophosphoryl Lipid A (MPL) as an adjuvant system was conducted to optimize a planned pivotal Phase III study.

Factors Associated with Allergen Immunotherapy-Related Systemic Reactions

The published rate of subcutaneous allergen immunotherapy (SCIT)-associated systemic reactions (SR) with conventional build-up protocols is 0.1-0.2% or 1-2 per 1,000 injection visits, but we have observed a higher rate locally. To evaluate overall safety and identify patterns and potential risk factors, we reviewed SR at two of our clinical sites.