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Kara Robertson
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Background Subcutaneous immunotherapy (SCIT) is the standard approach for treating patients with sensitizations to aeroallergens. However, immunotherapy can trigger severe systemic reactions if delivered inappropriately or to high risk patients. We sought to characterize and quantify SCIT systemic reactions requiring epinephrine administration during a 6-year period in a Canadian setting following the recommendations for components and dosages published in the 2010 Canadian Society of Allergy and Clinical Immunology (CSACI) Immunotherapy Manual.
Methods A single centre retrospective chart review was performed for all patients with systemic reactions to subcutaneous immunotherapy requiring intramuscular epinephrine injection between January 2011 and October 2017. Each systemic reaction requiring epinephrine was reviewed for baseline patient characteristics, details of the reaction, and reaction severity. Research ethics approval was obtained through McMaster University.
Results 28 of 380 patients experienced a systemic reaction requiring epinephrine administration, with an incidence rate of 1 per 1,047 injection visits (0.095%). 26 of the 28 reactions occurred within the mandatory 30-minute observation period post allergen immunotherapy. Of the 28 patients that experienced a systemic reaction to SCIT, 11 patients had asthma and 5 patients had a history of possible food allergy. All of the systemic reactions occurred during injections from vial number 4, and five patients reacted to their first shot of a re-ordered extract. 10 of the 28 patients required more than one intramuscular injection of epinephrine, and 20 of 28 patients were transferred to the hospital by ambulance.
Conclusions This is the first Canadian study to review patients with systemic reactions to subcutaneous immunotherapy. Several best practice methods were employed throughout the study to optimize subcutaneous delivery of immunotherapy extract, and our recorded per injection incidence rate for systemic reactions was comparable or below the rate published in similar studies. The recommendations in the CSACI Immunotherapy Manual provide an approach to standardizing prescriptions for SCIT to maximize immunotherapy efficacy and reduce the risk of systemic reactions, though similar studies in larger multicenter settings are needed to confirm these observations. These observations provide important objective information to clinicians about the potential risks for systemic reactions in patients considering SCIT.
Keywords
subcutaneous immunotherapy, SCIT, anaphylaxis, systemic reaction, allergic rhinitis, aeroallergen, epinephrine.
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CURRENT STATUS: Published
View the published article at Allergy, Asthma & Clinical Immunology.
No community comments so far
Editorial decision: Accept
On 16 Oct, 2020
Review #1 received
Received 07 Oct, 2020
Review #2 received
Received 06 Oct, 2020
Reviewer #2 agreed
On 02 Oct, 2020
Reviewer #1 agreed
On 25 Sep, 2020
Reviewers invited
Invitations sent on 25 Sep, 2020
Editor assigned
On 22 Sep, 2020
Submission checks complete
On 21 Sep, 2020
Editor invited
On 21 Sep, 2020
Version 3
Posted 04 Sep, 2020
No comments provided
Review #2 received
Received 17 Sep, 2020
Editorial decision: Accept but Needs Editing
On 17 Sep, 2020
Reviewer #2 agreed
On 09 Sep, 2020
Reviewers invited
Invitations sent on 08 Sep, 2020
Reviewer #1 agreed
On 08 Sep, 2020
Review #1 received
Received 08 Sep, 2020
Editor assigned
On 02 Sep, 2020
Submission checks complete
On 01 Sep, 2020
Editor invited
On 01 Sep, 2020
No comments provided
Review #2 received
Received 10 Aug, 2020
Editorial decision: Major revision
On 10 Aug, 2020
Review #1 received
Received 04 Aug, 2020
Reviewer #2 agreed
On 25 Jul, 2020
Editor assigned
On 24 Jul, 2020
Reviewers invited
Invitations sent on 24 Jul, 2020
Reviewer #1 agreed
On 24 Jul, 2020
Submission checks complete
On 23 Jul, 2020
Editor invited
On 23 Jul, 2020
No comments provided
Editorial decision: Major revision
On 13 Jul, 2020
Review #2 received
Received 12 Jul, 2020
Review #1 received
Received 04 Jul, 2020
Reviewer #2 agreed
On 28 Jun, 2020
Reviewer #1 agreed
On 26 Jun, 2020
Reviewers invited
Invitations sent on 26 Jun, 2020
Editor assigned
On 17 Jun, 2020
First submitted
On 16 Jun, 2020
Submission checks complete
On 16 Jun, 2020
Editor invited
On 16 Jun, 2020
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Subject Areas
Immunology
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at Allergy, Asthma & Clinical Immunology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Kara Robertson
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Allergy, Asthma & Clinical Immunology.
No community comments so far
Editorial decision: Accept
On 16 Oct, 2020
Review #1 received
Received 07 Oct, 2020
Review #2 received
Received 06 Oct, 2020
Reviewer #2 agreed
On 02 Oct, 2020
Reviewer #1 agreed
On 25 Sep, 2020
Reviewers invited
Invitations sent on 25 Sep, 2020
Editor assigned
On 22 Sep, 2020
Submission checks complete
On 21 Sep, 2020
Editor invited
On 21 Sep, 2020
Version 3
Posted 04 Sep, 2020
No comments provided
Review #2 received
Received 17 Sep, 2020
Editorial decision: Accept but Needs Editing
On 17 Sep, 2020
Reviewer #2 agreed
On 09 Sep, 2020
Reviewers invited
Invitations sent on 08 Sep, 2020
Reviewer #1 agreed
On 08 Sep, 2020
Review #1 received
Received 08 Sep, 2020
Editor assigned
On 02 Sep, 2020
Submission checks complete
On 01 Sep, 2020
Editor invited
On 01 Sep, 2020
No comments provided
Review #2 received
Received 10 Aug, 2020
Editorial decision: Major revision
On 10 Aug, 2020
Review #1 received
Received 04 Aug, 2020
Reviewer #2 agreed
On 25 Jul, 2020
Editor assigned
On 24 Jul, 2020
Reviewers invited
Invitations sent on 24 Jul, 2020
Reviewer #1 agreed
On 24 Jul, 2020
Submission checks complete
On 23 Jul, 2020
Editor invited
On 23 Jul, 2020
No comments provided
Editorial decision: Major revision
On 13 Jul, 2020
Review #2 received
Received 12 Jul, 2020
Review #1 received
Received 04 Jul, 2020
Reviewer #2 agreed
On 28 Jun, 2020
Reviewer #1 agreed
On 26 Jun, 2020
Reviewers invited
Invitations sent on 26 Jun, 2020
Editor assigned
On 17 Jun, 2020
First submitted
On 16 Jun, 2020
Submission checks complete
On 16 Jun, 2020
Editor invited
On 16 Jun, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Immunology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Allergy, Asthma & Clinical Immunology.
Background Subcutaneous immunotherapy (SCIT) is the standard approach for treating patients with sensitizations to aeroallergens. However, immunotherapy can trigger severe systemic reactions if delivered inappropriately or to high risk patients. We sought to characterize and quantify SCIT systemic reactions requiring epinephrine administration during a 6-year period in a Canadian setting following the recommendations for components and dosages published in the 2010 Canadian Society of Allergy and Clinical Immunology (CSACI) Immunotherapy Manual.
Methods A single centre retrospective chart review was performed for all patients with systemic reactions to subcutaneous immunotherapy requiring intramuscular epinephrine injection between January 2011 and October 2017. Each systemic reaction requiring epinephrine was reviewed for baseline patient characteristics, details of the reaction, and reaction severity. Research ethics approval was obtained through McMaster University.
Results 28 of 380 patients experienced a systemic reaction requiring epinephrine administration, with an incidence rate of 1 per 1,047 injection visits (0.095%). 26 of the 28 reactions occurred within the mandatory 30-minute observation period post allergen immunotherapy. Of the 28 patients that experienced a systemic reaction to SCIT, 11 patients had asthma and 5 patients had a history of possible food allergy. All of the systemic reactions occurred during injections from vial number 4, and five patients reacted to their first shot of a re-ordered extract. 10 of the 28 patients required more than one intramuscular injection of epinephrine, and 20 of 28 patients were transferred to the hospital by ambulance.
Conclusions This is the first Canadian study to review patients with systemic reactions to subcutaneous immunotherapy. Several best practice methods were employed throughout the study to optimize subcutaneous delivery of immunotherapy extract, and our recorded per injection incidence rate for systemic reactions was comparable or below the rate published in similar studies. The recommendations in the CSACI Immunotherapy Manual provide an approach to standardizing prescriptions for SCIT to maximize immunotherapy efficacy and reduce the risk of systemic reactions, though similar studies in larger multicenter settings are needed to confirm these observations. These observations provide important objective information to clinicians about the potential risks for systemic reactions in patients considering SCIT.
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