AAAAI/ACAAI subcutaneous immunotherapy (SCIT) surveillance study (2013-2017): fatalities, infections, delayed reactions and use of epinephrine auto-injectors

Publication date: Available online 15 February 2019

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Tolly G. Epstein, Gary M. Liss, Karen Murphy Berendts, David I. Bernstein

Abstract

Background

SCIT is highly effective but safety risks exist.

Objective

The aims of this study were to: 1) identify clinical practices that could influence fatal and non-fatal systemic allergic reactions (SRs) to SCIT; and 2) identify SCIT-associated infections.

Methods

From 2008-2016, 27-51% of AAAAI/ACAAI members completed an annual survey of SCIT-related SRs of varying severity. Post-injection local cutaneous and systemic infections were queried for 2014-2016. For 2014-2016, respondents were queried about timing of onset of SRs, post-injection waiting times, and prescription/use of epinephrine auto-injectors.

Results

Data were gathered on 54.4 million injection visits (2008-2016). Two confirmed fatalities from SCIT occurred between 2008-2014. An additional five confirmed fatalities occurred between 2015-2017. No infections occurred in 17.3 million injection visits (2014-2016). Among practices monitoring patients for at least 30 minutes, 15% of SRs occurred after 30 minutes. Practices prescribing an epinephrine auto-injector >90% of the time (29% of practices) did not experience lower rates of delayed Grade 3/4 SRs. Of patients experiencing Grade 3/4 delayed SRs, 26% and 8% used prescribed self-injectable epinephrine devices during 2014-2015 and 2015-2016, respectively.

Conclusions

There is an unexplained slight increase in SCIT-related fatalities for 2015-2017, although mean annual reported events over 9 years (0.8 fatal reactions/year) have declined. SCIT-related infections were not identified during two years of surveillance. The 15% incidence of delayed-onset SRs (> 30 min) is similar to a prior annual survey. Prescribing epinephrine auto-injectors for SCIT does not appear to improve outcomes, possibly due to low rates of self-administration.

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