A Case of Anaphylaxis after the First Dose of Sublingual Immunotherapy with House Dust Mite / 소아알레르기및호흡기학회지

ABSTRACT

The advantages of sublingual immunotherapy (SLIT) are its friendly route of administration and less frequent occurrence of severe side-effects. The most frequently reported events were irritation of the throat and oral itching. According to the recent data, the number of side effects seems to be dose-dependent. We report on one case of anaphylaxis after the first dose of SLIT with house dust mite drop. A 10-year-old girl suffered from severe allergic rhinitis with perennial symptoms and asthma for which a low dose inhaled corticosteroid was used. Her allergy workup disclosed a positive skin prick test to Dermatophagoides pteronyssinus, Dermatophagoides farinae, birch, hazel tree, alder, dog, cat, platane, and acacia pollens. We started SLIT (Pangramin SLIT, ALKAbello, Madrid, Spain) with D. pteronyssinus and D. farinae. Fifteen minutes after the first dose taken at home, she experienced local irritation, lip swelling, facial rash, rhinorrhea and cough. Provocation test was performed in the clinic with the same drug (0.00015 microg/drop, 1.6 STU/mL of D. pteronyssinus and D. farinae, respectively). After twenty minutes, she reported lip swelling, perioral wheals, rash and cough. Wheezing was aggravated, and peak expiratory flow rate (PEFR) dropped by 13% compared to prechallenge PEFR. We stress to have the first dose of SLIT taken in the clinic with an observation period.