Santos N, Pereira AM, Silva R, Torres da Costa J, Plácido JL. Systemic reactions to subcutaneous immunotherapy with airborne allergens – a first characterization according to WAO’s grading system. Allergy 2011;66(Suppl.94):138.

1. 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