Subcutaneous immunotherapy in hemophilic patients

What is it about?

Subcutaneous immunotherapy (SCIT) is a safe and effective treatment for allergic rhinitis, and its adverse effects are usually mild (1). However, the clinical benefits are accompanied by complex immunological changes that could be dangerous in some patients. Recently, we published a case report about late recurrence of inhibitor antibodies against factor VIII (FVIII) in a hemophilic patient when he started desensitizing therapy using allergenic vaccines against grass pollen (2). The reappearance of the inhibitor coincided with the simultaneous administration of FVIII recombinant concentrates and SCIT, suggesting the existence of a causal relationship between SCIT and development of the inhibitor. We speculated that parenteral administration of a peptide antigen, as exogenous FVIII, coinciding with increased T helper 1 (Th1) lymphocytes favored by SCIT, could lead to an immunological “danger signal,” culminating in the alloantibody development. References 1. Roche AM, Wise SK. Subcutaneous immunotherapy. Int Forum Allergy Rhinol. 2014;4(S2):S51–S54. 2. Bermejo N, Martın Aguilera C, Carnicero F, Bergua J. Allergenic vaccines administration and inhibitor devel-popment in haemophilia. Haemophilia. 2012;18:e392–e393.

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