[Risk factors analysis of systemic adverse reactions to subcutaneous immunotherapy for dust mites in children with respiratory allergic diseases].

Objective

To analyze the risk factors for systemic reaction (SR) in children with allergic rhinitis (AR) and (or) allergic asthma (AA) undergoing house dust mite subcutaneous immunotherapy (SCIT).

Methods

A prospective cohort study was conducted involving 531 children at the Department of Respiratory Medicine of Shenzhen Children's Hospital between March 2023 and December 2024, who received house dust mite SCIT. Data collected included age, gender, comorbidities, allergy profile, along with results of skin prick tests, serum house dust mite-specific IgE, and pulmonary function tests. Information regarding the clinical manifestations and severity grading of SCIT-induced SR was recorded. Based on the occurrence of SR during SCIT, the children were divided into an SR group and a non-SR group. The chi-square test or Mann-Whitney test was used to compare general conditions and clinical characteristics between the two groups, and Logistic regression was used to analyze the risk factors for SR.

Results

A total of 531 children were enrolled, receiving 11 616 injections of house dust mite SCIT. Among them, 368 cases were male and 163 cases were female, with an age at presentation of 8.2 (5.0, 10.0) years. There were 281 cases (52.9%) children with AR alone and 250 cases (47.1%) with both AR and AA. SR occurred in 118 cases, while 413 cases did not experience SR. SR occurred in 118 children (22.2%), accounting for 247 episodes (2.1%) injection-related events. Among these events, 156 episodes (63.2%) were Grade Ⅰ SR, 76 episodes (30.8%) were Grade Ⅱ SR, and 15 episodes (6.1%) were Grade Ⅲ SR. No Grade Ⅳ SR occurred. In the SR group, the proportions of those receiving non-standardized drug treatment, those with a skin prick test reaction of ≥3+ to dermatophagoides pteronyssinus and dermatophagoides farinae, and those with specific IgE levels of ≥17.5 kU/L to dermatophagoides pteronyssinus and dermatophagoides farinae were higher than those in the non-SR group (all P<0.05). Multivariate Logistic regression analysis identified the following as independent risk factors for SR (all P<0.05): a history of atopic dermatitis (OR=2.20, 95%CI 1.34-3.68), a history of repeated local adverse reaction (LR) (OR=2.08, 95%CI 1.11-3.92), respiratory infection within the past week (OR=1.85, 95%CI 1.07-3.19), and cluster therapy (OR=1.76,95%CI 1.13-2.76).

Conclusions

House dust mite SCIT demonstrates a favorable safety profile in children. Increased vigilance for SR is warranted during SCIT for children with a history of atopic dermatitis, a history of recurrent LR, cluster therapy, or a recent respiratory infection within the past week.