Severe repeated anaphylactic reactions to sublingual immunotherapy.
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Severe repeated anaphylactic reactions to sublingual immunotherapy.
Allergol Immunopathol (Madr). 2012 Dec 17;
Authors: Vovolis V, Kalogiros L, Mitsias D, Sifnaios E
Abstract
Sublingual immunotherapy (SLIT) for allergic rhinitis is a well-established and effective therapy. To date only 11 reports of anaphylaxis to SLIT have been published. Our case relates to a female patient receiving SLIT to Olea europaea pollen and House Dust Mites (HDMs). She had an unremarkable medical history, apart from persistent, perennial rhinoconjunctivitis and controlled asthma with seasonal aggravation. During the build-up phase of immunotherapy our patient suffered severe anaphylactic episodes during every attempt to increase the dose of Olea extract, according to ordinary regiment. Therefore, we adopted a modified build-up protocol administering incremental doses of saline dilution of original extract, in 30-min intervals. Following this modified scheduled regiment we managed to advance SLIT and a maintenance dose of three drops per day (lower than the ordinary dose) was reached. On the contrary, SLIT to HDMs advanced with no reaction, and the maintenance dose was reached in five days. Although SLIT seems to have an excellent safety profile this does not rule out the possibility of an anaphylactic reaction even if current guidelines have been followed precisely. Our case indicates that SLIT schedules with large doses of allergens, omitting up-dosing phase, could be not safe enough for a minority of high sensitive patients to whom a more gradual dose increase may be necessary.
PMID: 23253689 [PubMed - as supplied by publisher]