Modification of allergen subcutaneous immunotherapy safety precautions and systemic allergic reaction rate reduction

• Published in: Immunotherapy 2023-11, Vol.15 (16), p.1389-1400
• Main Authors: Mahlab-Guri, Keren, Mishayev, David, Yakovlev, Marina, Asher, Ilan, Sthoeger, Zev, Guri, Alex, Elbirt, Daniel, Nemet, Shay, Rosenberg-Bezalel, Shira
• Format: Article
• Language: English
• Subjects: allergic rhinitis; asthma; safety precautions; subcutaneous immunotherapy; systemic allergic reaction
• ISSN: 1750-743X; 1750-7448
• DOI: 10.2217/imt-2023-0072

Despite their life-threatening potential, medical team mistakes during subcutaneous immunotherapy are rarely discussed. Real data are missing, and a survey study estimated that dosing errors are responsible for 25% of systemic reactions during immunotherapy. To minimize errors, we modified our safety precautions and compared the rates of systemic allergic reactions before and after the change. Our retrospective comparative cohort study compared systemic allergic reaction rates during 2012–2015 and 2016–2019, after a second check of the injected allergen/s by another nurse/physician was added to the treatment protocol. The rate of systemic allergic reaction per injection was reduced from 0.93 to 0.71%; p = 0.023. A second check prior to injection is beneficial and can reduce the allergic reaction rate during immunotherapy. Many people suffer from allergies to dust or pollen, and they might suffer from a running nose when they come into contact with the allergens. This reaction is called hayfever or allergic rhinitis. Immunotherapy is a treatment which can help to treat patients with allergic rhinitis. During treatment, the patients receive injections of small amounts of dust or pollen, and with time become less allergic. The injections themselves might cause allergic reactions such as rash, hives, swelling or trouble breathing. Sometimes these allergic reactions are related to mistakes made by the medical team. In our study we changed safety instruction to add a second check of the materials and amounts before the injections were given to the patient. This was checked by two different nurses. We compared the number of allergic reactions to the shots before and after the change. We found that the number of allergic reactions was 9.3 for 1000 injections before and 7.1 for 1000 injections after the change. We think that a second check of the materials and amounts before giving the injections is helpful and can prevent some of the allergic reactions. Despite life-threatening potential, medical team mistakes during subcutaneous immunotherapy are rarely discussed. Double checking prior to injection is beneficial and reduced the allergic reaction rate from 0.93 to 0.71%; p = 0.023.