Allergen-specific subcutaneous immunotherapy–pain evaluation in pediatric age

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Cristiana Ferreira
Isabel Rezende
Arminda Guilherme
Inês Lopes


pain, allergen-specific subcutaneous immunotherapy, allergic pediatrics patients


Background: Allergen-specific immunotherapy is a potentially disease-modifying therapy that is effective for the treatment of patients with allergic diseases. Although the pain caused by the administration of subcutaneous immunotherapy with allergens (SCITA) is considered to be minimal, no studies assessing that pain for the treatment of only pediatric patients have been reported. 

Objectives: This research aimed to evaluate the pain associated with SCITA for pediatric patients followed at our Immunoallergology Department.

Methods: During four consecutive weeks, the nurse who administered the injection completed a questionnaire recording the child’s assessment of the pain associated with SCITA; these questionnaires were randomized before any analyses were done. Two different pain evaluation scales were used, with the choice of scale being determined based on the child’s age: the self-reporting faces scale (score: 0–10; 5 to 8 years old) and the numeric scale (score: 0–10; >8 years old). Demographic and clinical data, as well as any adverse reactions, were documented.

Results: We included 46 pediatric patients (mean age: 12.3 ± 2.6 years; 69.5% male), most of whom were suffering from rhinitis/rhinoconjunctivitis and undergoing subcutaneous immunotherapy with mites. Seven local adverse reactions were recorded, and all were mild. Ten patients did not mention any pain associated with SCITA. Of the 36 patients who mentioned some pain, 33 mentioned mild pain (scores between 1 and 3); only three mentioned moderate pain (scores between 4 and 6). For both scales, the median score obtained was 1. The maximum pain reported had a score of 6. No significant differences were observed between different groups of patients.

Conclusions: In this study, SCITA was shown to be a mildly painful procedure that is associated with only a few local reactions. Therefore, SCITA should be considered as a safe option for the treatment of most pediatric patients suffering from allergies.

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