Safety of a Modified Environmental Rush Immunotherapy Protocol in Children

Many variations of accelerated environmental immunotherapy protocols have been proven safe and effective in adults, but data on its use in the pediatric population is lacking. We aimed to evaluate the safety of modified environmental rush immunotherapy in children. Demographic and clinical data were gathered retrospectively from pediatric (age 7-18) and adult (age >18) patients who underwent modified environmental rush immunotherapy in an outpatient allergy clinic from 2017 to 2019. Aeroallergen sensitization was determined by either skin prick testing or measurement of serum-specific IgE. Data was analyzed using JMP software. In total, 77 patients were included in the study: 34 children and 43 adults. No differences were found in systemic (2 vs. 4, p=0.6) and local (4 vs. 10, p=0.2) reaction rates between children and adults, respectively. Systemic reactions were more likely in adults on inhaled corticosteroids with or without a long-acting beta-agonist (p=0.001) and history of asthma (p=0.02). Local reactions were more common in children on inhaled corticosteroids with or without a long-acting beta-agonist (p=0.03). Rates of systemic reactions with accelerated immunotherapy were not shown to be different between the pediatric and adult populations. Adults with a history of asthma or on an asthma maintenance medication were more likely to have systemic reactions, while children on maintenance asthma medications were more at risk for only local reactions, suggesting that accelerated immunotherapy may be safer in children than adults.