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Grass-pollen-allergy-immunotherapy/timothy-grass-pollen-allergen-extract-(grastek)

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Various toxicities: 2 case reports In a case series of 4 patients, two patients were described. A 33-year-old man developed mouth ulcers, tongue swelling, numbness, anaphylactic reaction and oral swelling following treatment with timothy grass pollen allergen extract and grass pollen allergy immunotherapy as allergen immunotherapy (AIT). A 31-year-old man developed mouth swelling following treatment with timothy grass pollen allergen extract as AIT [time to reaction onsets and outcomes not stated]. Case 1: A 33-year-old man had seasonal allergic rhinitis and asthma. His symptoms had not been controlled by montelukast, unspecified steroids, antihistamines and cromoglicate. Skin prick testing showed positive result for grass pollen. Serum-specific IgE was also positive for a range of grass. Therefore, he was initiated on sublingual AIT with timothy grass pollen allergen extract [timothy grass (Phleum pretense) allergen extract] 75000 standardised quality units tablet (SQ-T; Grazax oral lyophilisate). However, over the course of a few days after starting immunotherapy, he developed mouth ulcers, tongue swelling and numbness. The mouth ulcers persisted for some time. Therefore, timothy grass pollen allergen extract was discontinued. Thereafter, he started receiving subcutaneous immunotherapy with grass pollen allergy immunotherapy [grass pollen Alutard SQ]. He progressed well through updosing and initial maintenance. He received maintenance injections at 100000 standardised quality units (SQ-U) for 18 months. However, he developed anaphylactic reaction requiring hospitalisation and epinephrine treatment. Hence, grass pollen allergy immunotherapy was also discontinued. Subsequently, he started receiving sublingual immunotherapy with grass pollen allergy immunotherapy [Staloral grass pollen mix] starting at 1 press of 100 index of reactivity (IR)/mL, increasing gradually to 4 presses of 300 IR/mL solution. However, he developed problematic oral swelling. Therefore, grass pollen allergy immunotherapy was discontinued. Thereafter, he started receiving pre-seasonal grass pollen subcutaneous immunotherapy with dactylis glomerata/ Festuca pratensis/holcus lanatus/lolium perenne/phleum pratense/poa pratensis [Allergovit 6-grasses allergoid]. However, despite reaching the recommended maintenance dose of 6000 therapeutic units, he did not have a clinical response. Therefore, dactylis glomerata/Festuca pratensis/holcus lanatus/lolium perenne/phleum pratense/poa pratensis was discontinued. He subsequently initiated allergy immunotherapy leading to reasonable response. Case 3: A 31-year-old man with severe seasonal allergic rhinitis which was unresponsive to medical therapy with montelukast, unspecified antihistamines, intranasal steroids and cromoglicate. Allergen-specific IgE was found to be positive for a range of grass pollens. He started receiving sublingual AIT with timothy grass pollen allergen extract [timothy grass (Phleum pretense) a