Clinical and Immunological Correlates of Skin Prick Test Reactivity and Anaphylaxis During Allergen-Specific Immunotherapy in Children with Asthma and Allergic Rhinitis

Pardis  Shirkani; Shima  Khodadadi; Sudabeh  Mohammadi; Afshin  Shirkani

doi:10.18502/igj.v8i4.20102

Pardis Shirkani Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, BC, Canada
Shima Khodadadi Department of Immunology, Asthma and Allergy, The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
Sudabeh Mohammadi Assistant Professor of Community Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
Afshin Shirkani Allergy and Clinical Immunology Department, Bushehr University of Medical Sciences, School of Medicine, Bushehr, Iran

DOI: https://doi.org/10.18502/igj.v8i4.20102

Keywords: Skin Prick Test; Anaphylaxis; Subcutaneous Immunotherapy; Allergic Rhinitis; Asthma; IgE; Pediatric Allergy

Abstract

Background: Allergen-specific immunotherapy (AIT) is an effective treatment for allergic rhinitis and asthma, aiming to induce immune tolerance through repeated exposure to allergens. Although skin prick testing (SPT) is commonly used to identify sensitized individuals, its predictive value for systemic reactions during AIT, including anaphylaxis, remains uncertain. To investigate the correlation between the diameter of the wheal in SPT and the incidence of anaphylactic shock during subcutaneous immunotherapy in patients with allergic rhinitis and asthma.

Methods: This cross-sectional observational study included 255 pediatric patients aged 3–18 years with allergic rhinitis and/or asthma who underwent SPT at an allergy clinic in 2019. Patients with a positive SPT (wheal ≥3 mm) received subcutaneous AIT using standard allergen extracts for a period of three years. All patients were monitored for 20 minutes post-injection for adverse reactions. The size of SPT wheals was compared between patients who experienced anaphylactic reactions and those who did not.

Results: The mean age of patients was 10.2 ± 3.7 years; 68.2% were male. Of the 255 patients, 2.4% (n=6) experienced anaphylactic shock—two of grade I and four of grade II severity. Anaphylaxis occurred only in patients with allergic rhinitis or rhinitis combined with asthma; no cases were observed in patients with asthma alone (p=0.04). The average SPT wheal sizes for common allergens, particularly Dermatophagoides pteronyssinus, were slightly larger in patients with anaphylaxis, but the differences were not statistically significant (p>0.05).

Conclusion: There was no significant correlation between SPT wheal size and the risk or severity of anaphylaxis during AIT. However, allergic rhinitis appeared to be more associated with systemic reactions than asthma. These findings suggest that the magnitude of local skin reactivity may not reliably predict systemic hypersensitivity outcomes during immunotherapy. Further studies with larger sample sizes and more advanced immunological profiling are recommended.