FATALITIES FROM IMMUMOTHERAPY AND SKIN TESTING WITH ALLERGENIC EXTRACTS

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The Committee on Allergen Standardization has been surveying fatalities from IT. Prior reports presented data up to 1984, and 1285-89. This study reports 10 for 1990-91. Ten fatalities were reported associated with IT, none associated with skin testing (ST). Three males and 5 females were reported with 2 unreported. Ages were 12 to 73 with a mean of 49.1 years. Seven were asthmatic and 3 were not reported. Three were non-steroid dependent and stable, 1 was steroid dependent, 1 reported an ER visit, and the status of 5 was not reported. Allergic stnsitivity was reported as high or moderate in 6 and unreported in 4. None had cardiovascular disease and 6 were unreported. Six extracts contained pollens, 3 mold, 3 dust mite, 4 house dust, 2 cat, and 4 were unreported. Four contained standardized extracts, 2 did not, 4 were not reported. Three patients were reported on build-up, 3 on maintenance, and 4 were unreported. Doses associated with fatal reactions ranged from 0.4 ml 1/100,000 pollen, mold, dust mite, house dust to 0.3 ml 1/50 pollen mix. None were using beta-blockers or ACE inhibitors. One has a prior systemic reaction, 4 did not and 5 unreported. Two received inaccurate doses. An M.D. was present in 4, was not present in 2, and 4 were unreported. Onset of symptoms was <20 minutes in 5 and unreported in 5. Cause of death was asthma in 5 and 5 unreported. Fatal reactions associated with IT were reported to have occurred in 10 patients from January 1990 to the present. None were associated with ST. Although overall risk is low, asthmatics werw at the greatest risk for a fatal reaction. IT should be given by trained physicians aware of the risks and skilled in the treatment of anaphylaxis. Patients should be screened before each injection.