Subcutaneous immunotherapy as an effective treatment for allergy

Soumya Shraddhya Paul, Amity University Noida

Around 30% of the people around the world suffer from some sort of allergic issue making it one of the most prominent immune responses of our body. To deal with the allergies subcutaneous immunotherapy therapy (SCIT) works the best to provide some amount of relief or it can be seen as a form of treatment. The effectiveness along with the safety and efficacy of SCIT was established on how it manages stinging insect hypersensitivity, allergic conjunctivitis, allergic rhinitis, and allergic asthma. SCIT can also be considered in people with atopic dermatitis along with aeroallergen sensitization.

The subcutaneous immunotherapy therapy (SCIT) has shown its clinical relevance over the years but it still has the potential to cause severe or adverse reactions. Adverse reactions which are predicted can remain on the injection site or can systemically. It has been seen that systemic reactions are pretty rare with conventional protocol and are relevant in the rush protocol. As of now, several international societies has come together to develop a consensus on the use of allergen immunotherapy in clinical practice, with contribution from the American Academy of Allergy, Asthma, and Immunology (AAAAI), along with the European Academy of Allergy and Clinical Immunology (EAACI). The reports submitted have included a summary of the current state of immunotherapy along with the risk of systemic reactions. In the year 2016, a manual was published by the Canadian Society of Allergy and Clinical Immunology (CSACI) summarized other several risk factors, which included uncontrolled asthma and FEV1 < 70% predicted on spirometry, previous history of reaction from SCIT, various administration errors (improper doses, intramuscular injections) etc. Therefore, to counteract these adverse effects AAAAI, EAACI and CSACI along with that to reduce anaphylaxis shock, hence they have shared some strategies, that include regular screening for asthma, avoiding immunotherapy for patients suffering from respiratory-related issues etc. These all things can be implemented with proper coordination between patient, physician, and clinic staff. 

Brief about the Method

For this study, a quality improvement (QI) initiative was conducted in the Canadian academic Allergy and Immunology clinic from January–December 2019. Throughout this study, about 4242 subcutaneous injections were administered and around 860 patients were prescribed subcutaneous immunotherapy therapy (SCIT).

Results

As previously mentioned around 4242 injections of SCIT were administered in 12 months, out of these 10 people required epinephrine administration as they were seen to be showing systemic reaction this is almost 1 in 424 injections which in per cent gives 0.24%. Then it was noted that around eight people have documented risk factors related to systemic reaction and six people were having multiple risk factors. Major risk factors include uncontrolled asthma, seasonal exacerbation of allergic rhinitis, an error when it comes to the administration of the doses etc. All of these reactions occurred in the highest allergen extract concentration.

Conclusion

Through this study or QI initiative, researchers were trying to show or highlight the need to improve patient health care practitioner education and pre-administration screening. They provide various guidelines such as providing patients with written guidelines about the safety, screening of the patients before the administration of injections, dose adjustment, treatment plans for adverse asthma attacks etc.

Also read: Genetic biobank: a repository for the prevention of SIDS

References:

1. Aue, A., Ho, J., Zhu, R., Kim, H., & Jeimy, S. (2021). Systemic reactions to subcutaneous allergen immunotherapy: Real-world cause and effect modelling. Allergy, Asthma & Clinical Immunology, 17(1), 65. https://doi.org/10.1186/s13223-021-00566-x

Author info:

 Soumya Shraddhya Paul is an undergrad biotechnology student who worked in building 3D prosthetics in Base Hospital Delhi Cantt, and holds a key interest in nutraceuticals and enzymology.

Social Media Info: www.linkedin.com/in/soumya-shraddhya-paul-858229203

Publications:

1. https://bioxone.in/news/worldnews/understanding-b-cell-genomics-to-fight-against-covid-19/
2. https://bioxone.in/news/worldnews/the-current-ebola-epidemic-comes-to-an-end/

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