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Choi, Park, Yoon, Ahn, and Park: A Case of Anaphylaxis after the First Dose of Sublingual Immunotherapy with House Dust Mite
Abstract

Pediatr Allergy Respir Dis 2011;21(3):238-241.

Published online: 20 January 2011

DOI: https://doi.org/10.7581/pard.2011.21.3.238

A Case of Anaphylaxis after the First Dose of Sublingual Immunotherapy with House Dust Mite

Soo Young Choi, MD, Chung Soo Park, MD, Ji Hyun Yoon, MD, Young Min Ahn, MD, PhD, Hwa Young Park, MD, PhD

Department of Pediatrics, Eulji University School of Medicine, Seoul, Korea

책임저자: 박화영, 서울시 노원구 한글비석길 14 을지병원 소아과학교실 Tel: 02)970-8223 Fax: 02)976-5441 E-mail: phyoung@eulji.ac.kr

Received 18 July 2011       Revised 21 July 2011       Accepted 29 July 2011

Copyright © 2011 The Korean Academy of Pediatric Allergy and Respiratory Disease

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The advantages of sublingual immunotherapy (SLIT) are its friendly route of administration and less frequent occurrence of severe side-effects. The most frequently reported events were irritation of the throat and oral itching. According to the recent data, the number of side effects seems to be dose-dependent. We report on one case of anaphylaxis after the first dose of SLIT with house dust mite drop. A 10-year-old girl suffered from severe allergic rhinitis with perennial symptoms and asthma for which a low dose inhaled corticosteroid was used. Her allergy workup disclosed a positive skin prick test to Dermatophagoides pteronyssinus, Dermatophagoides farinae, birch, hazel tree, alder, dog, cat, platane, and acacia pollens. We started SLIT (Pangramin SLIT, ALK-Abello, Madrid, Spain) with D. pteronyssinus and D. farinae. Fifteen minutes after the first dose taken at home, she experienced local irritation, lip swelling, facial rash, rhinorrhea and cough. Provocation test was performed in the clinic with the same drug (0.00015 µg/drop, 1.6 STU/mL of D. pteronyssinus and D. farinae, respectively). After twenty minutes, she reported lip swelling, perioral wheals, rash and cough. Wheezing was aggravated, and peak expiratory flow rate (PEFR) dropped by 13% compared to prechallenge PEFR. We stress to have the first dose of SLIT taken in the clinic with an observation period.

Keywords: Sublingual immunotherapy, Anaphylaxis

References

1. Krouse JH. Sublingual immunotherapy for inhalant allergy: cautious optimism. Otolaryngol Head Neck Surg. 2009; 140:622–4.
2. Di Rienzo V, Marcucci F, Puccinelli P, Parmiani S, Frati F, Sensi L, et al. Long-lasting effect of sublingual immunotherapy in children with asthma due to house dust mite: a 10-year prospective study. Clin Exp Allergy. 2003; 33:206–10.
crossref
3. Marogna M, Tomassetti D, Bernasconi A, Colombo F, Massolo A, Businco AD, et al. Preventive effects of sublingual immunotherapy in childhood: an open randomized controlled study. Ann Allergy Asthma Immunol. 2008; 101:206–11.
crossref
4. Scadding GK, Durham SR, Mirakian R, Jones NS, Leech SC, Farooque S, et al. BSACI guidelines for the management of allergic and nonallergic rhinitis. Clin Exp Allergy. 2008; 38:19–42.
crossref
5. Stewart GE 2nd, Lockey RF. Systemic reactions from allergen immunotherapy. J Allergy Clin Immunol. 1992; 90(4 Pt 1):567–78.
crossref
6. Tari MG, Mancino M, Monti G. Efficacy of sublingual immunotherapy in patients with rhinitis and asthma due to house dust mite. A double-blind study. Allergol Immunopathol (Madr). 1990; 18:277–84.
7. Guez S, Vatrinet C, Fadel R, André C. House-dust-mite sublingual-swallow immunotherapy (SLIT) in perennial rhinitis: a double-blind, placebocontrolled study. Allergy. 2000; 55:369–75.
crossref
8. Cohen SG, Evans R 3rd. Allergen immunotherapy in historical perspective. Clin Allergy Immunol. 2004; 18:1–36.
9. Agostinis F, Foglia C, Landi M, Cottini M, Lombardi C, Canonica GW, et al. The safety of sublingual immunotherapy with one or multiple pollen allergens in children. Allergy. 2008; 63:1637–9.
crossref
10. Dunsky EH, Goldstein MF, Dvorin DJ, Beleca-nech GA. Anaphylaxis to sublingual immunotherapy. Allergy. 2006; 61:1235.
crossref
11. Antico A, Pagani M, Crema A. Anaphylaxis by latex sublingual immunotherapy. Allergy. 2006; 61:1236–7.
crossref
12. Eifan AO, Akkoc T, Yildiz A, Keles S, Ozdemir C, Bahceciler NN, et al. Clinical efficacy and immunological mechanisms of sublingual and subcutaneous immunotherapy in asthmatic/rhi-nitis children sensitized to house dust mite: an open randomized controlled trial. Clin Exp Allergy. 2010; 40:922–32.
crossref
13. Blazowski L. Anaphylactic shock because of sublingual immunotherapy overdose during third year of maintenance dose. Allergy. 2008; 63:374.
14. de Groot H, Bijl A. Anaphylactic reaction after the first dose of sublingual immunotherapy with grass pollen tablet. Allergy. 2009; 64:963–4.
crossref
15. Rhee CS. Immunotherapy for allergic rhinitis: current and future. Korean J Otolaryngol-Head Neck Surg. 2005; 48:1312–22.
16. Lombardi C, Gargioni S, Cottini M, Canonica GW, Passalacqua G. The safety of sublingual immunotherapy with one or more allergens in adults. Allergy. 2008; 63:375–6.
17. Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report–second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Ann Emerg Med. 2006; 47:373–80.
crossref
18. Simons FE. Anaphylaxis. J Allergy Clin Immunol. 2010; 125(2 Suppl 2):S161–81.
crossref

Table 1.
The results of Pangramin SILT provocation test
  Pre-challenge Post-challenge
Symptoms No Cough
Physical examination Mild wheezing Lip swelling, perioral wheal, rash, and wheezing aggravation
PEER (mL/min) 310 270 (13%↓)
BP (mmHg) 120/75 120/70

SILT, sublingual immunotherapy; PEFR, peak expiratory flow rate; BP, blood pressure.

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