Humans ; Consensus ; Hypersensitivity ; Desensitization, Immunologic/adverse effects* ; Immunotherapy/adverse effects* ; Injections, Subcutaneous ; Allergens

Objective: To investigate the incidence and risk factors of systemic allergic reactions induced by subcutaneous immunotherapy (SCIT) in patients undergoing SCIT injections in Peking Union Medical College Hospital (PUMCH). Methods: This is a single center retrospective cohort study. Using the outpatient information system of PUMCH, the demographic information and injection-related reaction data of patients undergoing SCIT injection in Allergy Department of PUMCH from December 2018 to December 2022 were retrospectively analyzed to count the incidence and risk factors of systemic allergic reactions caused by SCIT. Mann-Whitney nonparametric test or chi-square test was used for single-factor analysis, and multiple logistic regression was used for multiple-factor analysis. Results: A total of 2 897 patients received 18 070 SCIT injections in Allergy Department during the four years, and 40 systemic allergic reactions occurred, with the overall incidence rate of 0.22%. The incidence of systemic allergic reaction was 0.37% when using imported dust mite preparation and 0.15% when using domestic multi-component allergen preparation. The risk factors significantly related with SCIT-induced systemic allergic reactions in patients using imported dust mite preparation were age less than 18 years old (OR=3.186,95%CI: 1.255-8.085), highest injection concentration (OR value could not be calculated because all patients with systemic reactions were injected with highest concentration), and large local reaction in previous injection (OR=22.264,95%CI: 8.205-60.411). The risk factors for SCIT-induced systemic allergic reactions in patients using domestic allergen preparation were 5 or more types of allergens (OR=3.455,95%CI: 1.147-10.402), highest injection concentration (OR=3.794,95%CI: 1.226-11.740) and large local reaction in previous injection (OR=63.577,95%CI: 22.248-181.683). However, SCIT injection in pollen allergic patients during the pollen season did not show a correlation with systemic allergic reaction. Conclusion: The incidence of SCIT-induced systemic allergic reactions was low in the Chinese patient population of this study. Patients with one or more risk factors, such as multiple allergen injection, highest injection concentration, large local reaction in previous injection, should be given high attention and vigilance against systemic allergic reactions.
Humans ; Allergens ; Asian People ; Desensitization, Immunologic/adverse effects* ; Hypersensitivity/epidemiology* ; Retrospective Studies

Objective: To investigate the incidence and risk factors of systemic allergic reactions induced by subcutaneous immunotherapy (SCIT) in patients undergoing SCIT injections in Peking Union Medical College Hospital (PUMCH). Methods: This is a single center retrospective cohort study. Using the outpatient information system of PUMCH, the demographic information and injection-related reaction data of patients undergoing SCIT injection in Allergy Department of PUMCH from December 2018 to December 2022 were retrospectively analyzed to count the incidence and risk factors of systemic allergic reactions caused by SCIT. Mann-Whitney nonparametric test or chi-square test was used for single-factor analysis, and multiple logistic regression was used for multiple-factor analysis. Results: A total of 2 897 patients received 18 070 SCIT injections in Allergy Department during the four years, and 40 systemic allergic reactions occurred, with the overall incidence rate of 0.22%. The incidence of systemic allergic reaction was 0.37% when using imported dust mite preparation and 0.15% when using domestic multi-component allergen preparation. The risk factors significantly related with SCIT-induced systemic allergic reactions in patients using imported dust mite preparation were age less than 18 years old (OR=3.186,95%CI: 1.255-8.085), highest injection concentration (OR value could not be calculated because all patients with systemic reactions were injected with highest concentration), and large local reaction in previous injection (OR=22.264,95%CI: 8.205-60.411). The risk factors for SCIT-induced systemic allergic reactions in patients using domestic allergen preparation were 5 or more types of allergens (OR=3.455,95%CI: 1.147-10.402), highest injection concentration (OR=3.794,95%CI: 1.226-11.740) and large local reaction in previous injection (OR=63.577,95%CI: 22.248-181.683). However, SCIT injection in pollen allergic patients during the pollen season did not show a correlation with systemic allergic reaction. Conclusion: The incidence of SCIT-induced systemic allergic reactions was low in the Chinese patient population of this study. Patients with one or more risk factors, such as multiple allergen injection, highest injection concentration, large local reaction in previous injection, should be given high attention and vigilance against systemic allergic reactions.
Humans ; Allergens ; Asian People ; Desensitization, Immunologic/adverse effects* ; Hypersensitivity/epidemiology* ; Retrospective Studies

OBJECTIVETo retrospectively assess serious systemic adverse effects of standardized dust-mite vaccine in children with asthma.

METHODSMedical records of 704 children (5-17 years in age) with asthma between January, 2005 and December, 2011 were reviewed. Serious systemic adverse events following treatment with a standardized dust-mite vaccine in these children were analyzed.

RESULTSA total of 336 systemic adverse reactions were observed in 17.0% (120/704) of the patients analyzed of these adverse reactions, 18 (5.4%) were serious (level 3), 318 (94.6%) were not serious (below level 3), and no single case of anaphylactic shock (level 4) was recorded. Systemic adverse events occurred most frequently in the 5 to 11-year age group and in the summer season (from June to August). In the 18 severe cases, the peak expiratory flow (PEF) dropped by 20% immediately after the vaccine injection, and other major clinical symptoms included cough, wheezing and urticaria. All children with serious systemic adverse effects were given inhaled hormone and atomized short-acting beta agonists, oral antihistamines, intravenous dexamethasone and/or intramuscular adrenaline. After these treatments, the clinical symptoms were significantly relieved.

CONCLUSIONSThe rate of serious systemic adverse events following allergen-specific immunotherapy is relatively low in children with allergic asthma. Conventional medications are effective in managing these immunotherapy-associated adverse events.

Adolescent ; Animals ; Asthma ; physiopathology ; therapy ; Child ; Child, Preschool ; Desensitization, Immunologic ; adverse effects ; Female ; Humans ; Male ; Peak Expiratory Flow Rate ; Pyroglyphidae ; immunology ; Retrospective Studies ; Vaccines ; adverse effects

OBJECTIVE: To observe the adverse effects of specific immunotherapy (SIT) with standardized dust mite allergen preparation in the treatment of allergic rhinitis. METHOD: Three hundred and eighty-six patients with allergic rhinitis who received subcutaneous SIT with a standardized dust mite allergen preparation were enrolled in this study. The patients were treated for at least 15 weeks,adverse effects after each injection from dosing phase to maintenance phase were recorded and incidence of adverse effects were analyzed. RESULT: Of all the patients,adverse reactions occurred in 42 patients (10. 9%),10 local reactions (2. 6%) and 36 systemic side effects (9. 3%) which included 34 mild ,1 moderate and 1 severe side effects (no fatal) were reported respectively. None had anaphylactic shock. Among three treatment options, incidence of routine program was the highest (21.1%),followed by adult cluster program (11. 9%), adverse effects of children cluster program was the least (1. 5%). The adverse effects often happened in the middle and late phase of does addition period and early phase of maintenance period. CONCLUSION SIT with standardized dust mite allergen preparation in the treatment of allergic rhinitis is a safe and effective treatment by complying with the guidelines and taking specific interventions.
Adult ; Animals ; Antigens, Dermatophagoides ; adverse effects ; therapeutic use ; Child ; Desensitization, Immunologic ; Humans ; Immunotherapy ; Pyroglyphidae ; Rhinitis, Allergic ; therapy ; Treatment Outcome

OBJECTIVETo evaluate the therapeutic efficacy of 3-year subcutaneous immunotherapy (SCIT) in asthmatic children allergic to mite.

METHODSNinety asthmatic children allergic to house dust mite (with or without allergic rhinitis) and aged 5-14 years were randomized into SCIT treatment group (n=45) and control group (n=45). The SCIT treatment group received SCIT combined with standardized treatment for asthma, while the control group received the standardized treatment alone. The therapeutic effects were assessed based on the daytime and nighttime symptom scores, mean daily doses of inhaled corticosteroids (ICS), skin prick test results, peak expiratory flows and total serum IgE at baseline and in the 3-year treatment.

RESULTSIn both groups, the daytime and nighttime symptom scores in the first, second, and third years of treatment were significantly lower than the baseline values (P<0.01), and the scores decreased year by year during the 3-year treatment (P<0.01). Also, the mean daily doses of ICS in the first, second, and third years of treatment were significantly lower than the baseline values (P<0.01), and the doses decreased year by year during the 3-year treatment (P<0.01). The mean daily dose was significantly lower in the SCIT treatment group than in the control group in the second and third years of treatment (P<0.05). After 3-year treatment, the SCIT treatment group had a significantly higher proportion of children who discontinued use of ICS due to remission of symptoms compared with the control group (29% vs 20%, P<0.05). At the end of the 3-year treatment, the total serum IgE was significantly lower than the baseline value in the SCIT treatment group (P<0.01), and it was significantly lower in the SCIT treatment group than in the control group (P<0.05).

CONCLUSIONSThree-year SCIT is effective in asthmatic children allergic to house dust mite and allows reduction in the dosage of ICS.

Adrenal Cortex Hormones ; administration & dosage ; Animals ; Asthma ; immunology ; therapy ; Child ; Desensitization, Immunologic ; adverse effects ; methods ; Female ; Humans ; Immunoglobulin E ; blood ; Injections, Subcutaneous ; Male ; Pyroglyphidae ; immunology

OBJECTIVETo study the efficacy and safety of specific sublingual immunotherapy with dermatophagoides farinae drops in the treatment of cough variant asthma in children.

METHODSA total of 106 children aged 4-14 years old with cough variant asthma and positive skin prick test responses to dermatophagoides farinae allergens were randomly divided into two groups: SLIT group (n=53), which received specific sublingual immunotherapy with dermatophagoides farinae drops as well as standardized treatment and conventional treatment group (n=53), which received standardized treatment alone. Improvement in cough/asthma symptom scores and the time taken for symptoms to improve were observed after treatment. Serum eosinophil (EOS) level and peak expiratory flow (PEF) were measured after treatment. The side effects were observed.

RESULTSCompared with the conventional treatment group, the SLIT group showed significant decrease in symptom scores and serum EOS level and significant increase in PEF (P<0.05). The time at which symptoms began to improve in the SLIT group was earlier than in the conventional treatment group (P<0.05). The effective rate in the SLIT group was significantly higher than in the conventional treatment group (85% vs 68%; P<0.05). Local reactions such as redness, swelling, and itching occurred in some children of the SLIT group but disappeared on the following day.

CONCLUSIONSSpecific sublingual immunotherapy with dermatophagoides farinae drops is an effective and highly safe treatment for cough variant asthma in children.

Administration, Sublingual ; Adolescent ; Antigens, Dermatophagoides ; immunology ; Asthma ; therapy ; Child ; Child, Preschool ; Cough ; therapy ; Desensitization, Immunologic ; adverse effects ; Eosinophils ; physiology ; Female ; Humans ; Male

OBJECTIVETo investigate the incidence of local reactions (LRs) and systemic reactions (SRs) of subcutaneous immunotherapy (SCIT) and to analyze the potential risk factors of such reactions in Chinese population.

METHODThis is a retrospective study on 234 dust mite sensitized patients with allergic rhinitis and asthma who received allergen immunotherapy in our hospital from 2003 to 2010. Chart review was conducted to capture clinical data of reactions to immunotherapy. Parameters included signs and symptoms, the onset of reaction, and interventions in treating such reactions, particularly, the administration of epinephrine (EPI) and adjustment of vaccine dosage due to LRs and SRs.

RESULTThe 234 patients received a total of 7679 injections. Among them, 4973 LRs (64.8%) and 235 SRs (3.1%) were observed in 67 patients (28.6% of all patients). SRs included respiratory symptoms (205 events, 88.4%) and cutaneous symptoms (31.5%). Of the total of 235 SR events, 212 (90.2%) were presented as mild SRs and 23 (9.8%) were in severe SR category (grade III and grade IV, EAACI grading system). Overall, severe SRs accounted for 0.3% of total injections. Seventeen of the 23 SR events required epinephrine treatment (0.2% of total injections). Of the 67 patients, 61 completed the course of treatment after dose adjustment; 36 patients had their doses decreased prior to further advancing to target dose. Nineteen subjects tolerated splitting two injections at 30 minutes interval. Six patients advanced the dose based on protocol and another 6 had to stop immunotherapy. Most of the SRs (77.4%) occurred during the maintenance phase of immunotherapy. The levels of TIgE, SIgE D1 and SIgE D2 were found to be significantly higher in patients with SRs comparing to patients without SRs (P < 0.05). SRs more commonly occurred in patients with age less than 14 years than their older counterparts (95.5% vs. 85.6%, OR = 3.58, 95%CI = 1.040 - 12.322, P < 0.01). The incidence of SRs were significantly higher in asthma patients who received SCIT than non-asthma patients (OR = 2, 95%CI = 1.136 - 4.624).

CONCLUSIONOur study suggests that risk factors of SRs include maintenance phase (higher allergen vaccine doses), patients with asthma, age of less than 14 years, higher levels of TIgE, and SIgE D1 and SIgE D2. Effective management includes proper dose adjustment, splitting doses into 2 injections at 30 min apart, and strictly following immunotherapy indications.

Adolescent ; Adult ; Animals ; Antigens, Dermatophagoides ; administration & dosage ; immunology ; Asthma ; immunology ; therapy ; Child ; Child, Preschool ; Desensitization, Immunologic ; adverse effects ; methods ; Female ; Humans ; Hypersensitivity, Immediate ; epidemiology ; etiology ; therapy ; Injections, Subcutaneous ; Male ; Middle Aged ; Mites ; immunology ; Retrospective Studies ; Rhinitis, Allergic, Perennial ; immunology ; therapy ; Risk Assessment ; Treatment Outcome ; Young Adult

Paragonimiasis is an infectious disease caused by trematodes of the genus Paragonimus. This trematode can be treated successfully with praziquantel in more than 90% of the cases. Although praziquantel is generally well tolerated, anaphylactic reactions to this drug have been reported in a few cases. We report here a 46-year-old Korean female with paragonimiasis, presumed to be due to Paragonimus westermani, who displayed an allergic reaction to praziquantel and resistance to triclabendazole treatment. The patient was successfully treated with praziquantel following a rapid desensitization procedure. Desensitization to praziquantel could be considered when no alternative drugs are available.
Animals ; Benzimidazoles/*therapeutic use ; *Desensitization, Immunologic ; Drug Hypersensitivity/etiology/immunology/*therapy ; *Drug Resistance ; Female ; Humans ; Middle Aged ; Paragonimiasis/*drug therapy/immunology/parasitology ; Paragonimus/isolation & purification/physiology ; Praziquantel/*adverse effects/*immunology/therapeutic use ; Treatment Outcome

OBJECTIVE: To evaluate the adverse reaction of standardized specific mite-allergen immunotherapy. METHOD: One hundred and fifty-two patients diagnosed by the pediatric immunotherapy center of our hospital were treated with increasing doses of standardized specific mite-allergen injection. Before and 30 minutes after treatment, the peak expiratory flow (PEF) and pulmonary function for the maximum lung ventilation function were checked, and the adverse reactions were recorded. RESULT: Six hundred and eighty-one injections were recorded. 84 injections (12.3%) caused immediate side effects, including 64 mild local adverse reactions (9.4%), 2 moderate local adverse reactions (0.3%), 18 systemic adverse reactions (2.6%) which were mild asthma, and no fatal anaphylactic shock and other serious adverse reactions were found. 50 injections (7.3%) cased delayed adverse reactions, all of which were mild local adverse reactions. The rate of immediate local adverse reactions and systemic adverse reactions in the maintenance treatment period was significantly higher than that in the initial treatment period (chi2 = 4.59, 19.82 respectively; P < 0.05, < 0.01 respectively). The rate of delayed adverse reactions was no significant differences (chi2 = 2.30; P > 0.05). The PEF change rate (-0.000 2 +/- 0.085 9) of the children at 681 injections and the MMEF change rate of the children at 109 injections (0.275 +/- 0.206) were not statistically different (t = -0.047, 1.39; P = 0.963, 0.166). CONCLUSION Standardized specific mite-allergen immunotherapy is safe for children with allergic rhinitis and/or asthma.
Adolescent ; Animals ; Asthma ; immunology ; therapy ; Child ; Child, Preschool ; Desensitization, Immunologic ; adverse effects ; standards ; Dose-Response Relationship, Immunologic ; Female ; Humans ; Hypersensitivity, Immediate ; Male ; Mites ; immunology ; Rhinitis, Allergic, Perennial ; immunology ; therapy