Reducing and managing systemic reactions to immunotherapy

Purpose of review To identify and discuss recent articles pertaining to the reduction and management of systemic reactions to allergen immunotherapy (AIT). Recent findings Fatal reactions to AIT may be declining. Screening asthma patients before AIT and dose adjustment during pollen season may contribute to lower systemic reaction rates. Cluster build-up protocols with multiallergen subcutaneous immunotherapy (SCIT) may lead to an increased risk of systemic reactions compared with cluster build-up protocols with single-allergen SCIT. Sublingual immunotherapy (SLIT) studies confirm the low rates of systemic reactions using this method, including for rapid build-up schedules. Studies of newer forms of AIT (intralymphatic, epicutaneous, recombinant allergens) have too few patients to form confident systemic reaction risk estimates. High-grade delayed systemic reactions to AIT may be less frequent than previously reported. Summary Recent studies increase confidence in risk estimates for systemic reactions to AIT, suggest useful strategies to predict systemic reactions to AIT, and offer strategies to prevent systemic reactions.