183 Incidence of Systemic Reactions (SRS) to Prick (P) and Intradermal (ID) Tests, Response to Immediate (“STAT”) Epinephrine IM (EPI IM) Dose versus BMI, Number of Delayed SRS, and WAO Systemic Reaction Grade

BACKGROUND: To determine the incidence of SRs to P and ID tests, the response to stat epi IM, number of delayed SRs, the dose of epi IM versus BMI and the World Allergy Organization (WAO) Grade (1-5) of the SRs. METHODS: SRs were compiled from 07/2010 to 06/2011 to P and ID tests for any combination of approximately 20 allergens (pollens, animal emanations, molds and Hymenoptera) in 1,332 subjects. Nurses administered stat epi IM (1:1000 v/v), 0.2 mg IM, into the arm or thigh for any signs or symptoms (SS) of a SR, including, but not limited to, itchy eyes, nose, pharynx, or palms; rhinorrhea, nasal congestion, sneezing; and generalized erythema, skin pruritus, or urticaria. SS (WAO Grade), total epi IM dose, and delayed SRs were recorded. Repeat doses of epi IM were given if SS persisted or worsened. RESULTS: 31 (2%) had SRs: 24 (77%) female, 7 (23%) male; 5 (16%) pediatric, 26 (84%) adult. Of the 31 SRs, 26 (84%) had Grade 1, 5 (16%) Grade 2 and Grades 3 to 5. 13 (42%) experienced SS during P and 18 (58%) during ID or at the completion of P and ID. All received stat epi IM with any SS. 2 BMIs were not available. 28 SRs, with a mean BMI of 28.5 (overweight range 25.0–29.9) received one epi IM, 0.2 mg, and one BMI 20.4 (normal range 18.5–24.9) received 2 epi IM (total 0.3 mg). There were no underweight (less than 18.5) or obese (30.0 or greater) subjects. CONCLUSIONS: 31 (2%) had SRs to P and/or ID tests; 30 received one epi IM dose (0.2 mg) and one, 2 doses (0.3 mg total). There were no delayed SRs or relationship of epi IM dose to BMI and all but one were WAO Grade 1 reactions. Stat use of EPI IM may prevent more serious SRs and delayed reactions.