Adverse reactions of rush subcutaneous immunotherapy using standardized house dust mite allergen extract and its prediction model construction and analysis

Background: Allergic diseases are a growing health concern, with house dust mites being a prevalent allergen linked to various allergies. Rush subcutaneous immunotherapy (RIT) achieves maintenance dose rapidly but carries higher risks than conventional immunotherapy (CIT). The combination of Omalizumab with allergen immunotherapy (AIT) has been shown to improve AIT safety. This study investigates the safety of RIT combined with anti-immunoglobulin E (IgE) pretreatment. Methods: This retrospective analysis compared patients with allergic rhinitis and/or allergic asthma sensitive to dust mites who underwent RIT with anti-IgE pretreatment versus CIT at our facility from July 2022 to January 2024. We collected and analyzed demographic data, adverse events, and baseline metrics including visual analog scale scores, daily medication scores, allergic blood test outcomes, and lung function parameters. Results: Our study enrolled 50 patients in the RIT group and 60 in the CIT group. The RIT group demonstrated superior safety, with significantly fewer local adverse reactions during the up-dosing phase compared with CIT ( P < 0.01). While systemic reactions were analogous between groups, the RIT group had a lower incidence of respiratory symptoms ( P < 0.05). Logistic regression analysis established a predictive model for systemic reactions during up-dosing phase, with receiver operating characteristic analysis indicating its predictive accuracy exceeded that of individual factors (area under the curve = 0.815). Conclusion: RIT combined with anti-IgE pretreatment demonstrated low systemic adverse reaction rates and high safety. A combined visual analogue scale scores (VASs) and maximal mid-expiratory flow at 25%–75% prediction model was more accurate in forecasting systemic reactions than individual factor. Further research is required to determine its clinical utility.