Improved Tolerance Of Subcutaneous Immunotherapy In Pediatric Patients Through The Use Of Comfort Devices: A Quality Improvement Project

Pain and swelling are common adverse reactions of allergen subcutaneous immunotherapy (SCIT) and can affect its tolerability in many children We conducted a quality improvement project with the use of pain control interventions (Buzzy® vibratory device and ice packs) with SCIT. We administered patient/parent surveys to pediatric SCIT patients prior to SCIT to assess for history of pain or swelling with SCIT and the child’s current level of coping with SCIT (0=coped very poorly, 5= coped very well) and after 30 minutes of SCIT. Fifteen parents/patients completed pre and post-SCIT surveys from June-August 2018. Baseline pre-SCIT surveys revealed a history of pain and swelling with SCIT in 27% (4/15) and 40% (6/15) children, respectively. 80% (12/15) used the offered comfort devices. The 3 patients who declined comfort measures reported tolerating SCIT without pain or swelling. Half (6/12) of patients who received comfort measures had a history of pain or swelling. 75% (9/12) used ice, 17% (2/12) used ice and the vibratory device, and 8% (1/10) used the vibratory device. Comfort measures improved pain and swelling in 92% (11/12) and 100% (12/12), respectively. All (6/6) patients with a history of pain or swelling with SCIT reported improvement with comfort measures. There was significant improvement in parental anxiety with comfort measures (P<0.001). The majority of pediatric patients tolerate SCIT well. Those with a history of pain or swelling with SCIT had improvement with the use of non-pharmacologic comfort measures. Increasing awareness of comfort measures will improve SCIT tolerability.