Allergy Asthma Immunol Res.  2019 Nov;11(6):846-855. 10.4168/aair.2019.11.6.846.

Safety of Ultra-rush Schedule of Subcutaneous Allergen Immunotherapy With House Dust Mite Extract Conducted in an Outpatient Clinic in Patients With Atopic Dermatitis and Allergic Rhinitis

• Lee SH
• Kim ME
• Shin YS
• Ye YM
• Park HS
• Nahm DH

• KMID: 2459188
• DOI: http://doi.org/10.4168/aair.2019.11.6.846

Abstract

PURPOSE
Ultra-rush schedule of subcutaneous allergen immunotherapy (UR-SCIT) administering maximum maintenance dose of allergen extract within one day can save time and effort for allergen immunotherapy in patients with allergic disease. However, UR-SCIT is associated with an increased risk of systemic reaction (SR) and typically has been conducted in a hospital admission setting. To overcome disadvantages of UR-SCIT, we evaluated the safety of UR-SCIT conducted in an outpatient clinic in patients with atopic dermatitis (AD) and allergic rhinitis (AR).
METHODS
UR-SCIT was performed in 538 patients with AD and/or AR sensitized to house dust mite (HDM). A maximum maintenance dose of tyrosine-adsorbed HDM extract (1 mL of maintenance concentration) was divided into 4 increasing doses (0.1, 0.2, 0.3, and 0.4 mL) and administered to the patients by subcutaneous injection at 2-hour intervals for 8 hours in an outpatient clinic. SRs associated with UR-SCIT were classified according to the World Allergy Organization grading system.
RESULTS
SR was observed in 12 of 538 patients (2.2%) with AD and/or AR during UR-SCIT. The severity grades of the observed SRs were mild-to-moderate (grade 1 in 7 patients, grade 2 in 4 patients, and grade 3 in 1 patient). The scheduled 4 increasing doses of HDM extract could be administered in 535 of 538 patients (99.4%) except 3 patients who experienced SR before administration of the last scheduled dose. SR was observed within 2 hours in 11 patients after administration of the scheduled doses of HDM extract except one patient who experienced a grade 2 SR at 5.5 hours after administration of the last scheduled dose.
CONCLUSIONS
UR-SCIT with tyrosine-adsorbed HDM extract conducted in an outpatient clinic was tolerable in patients with AD and AR. UR-SCIT can be a useful method to start a SCIT in patients with AD and AR.

Keyword

Desensitization; dermatitis, atopic; allergic rhinitis

MeSH Terms

Ambulatory Care Facilities*
Appointments and Schedules*
Dermatitis, Atopic*
Desensitization, Immunologic*
Dust*
Humans
Hypersensitivity
Injections, Subcutaneous
Methods
Outpatients*
Pyroglyphidae*
Rhinitis, Allergic*
Dust

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