Allergy shots: Do patients feel pain or fear? | Allergologia et Immunopathologia

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Suppression of eosinophil, mast cells and basophil migration to tissues. Suppression of mucus production." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Álvaro, J. Sancha, H. Larramona, J.M. Lucas, M. Mesa, A.I. Tabar, A. Martinez-Cañavate" "autores" => array:9 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Álvaro" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Sancha" ] 2 => array:2 [ "nombre" => "H." "apellidos" => "Larramona" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Lucas" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Mesa" ] 5 => array:2 [ "nombre" => "A.I." "apellidos" => "Tabar" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Martinez-Cañavate" ] 7 => array:1 [ "colaborador" => "Immunotherapy Working Group" ] 8 => array:1 [ "colaborador" => "Sociedad Española de Inmunología Clínica y Alergia Pediátrica (SEICAP)" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054612003011?idApp=UINPBA00004N" "url" => "/03010546/0000004100000004/v1_201307160011/S0301054612003011/v1_201307160011/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "Research letter" "titulo" => "Allergy shots: Do patients feel pain or fear?" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "273" "paginaFinal" => "275" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.B. Ferreira, L.P. Viegas, A.S. Santos, M.P. Barbosa" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M.B." "apellidos" => "Ferreira" "email" => array:1 [ 0 => "mbrancoferreira@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L.P." "apellidos" => "Viegas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A.S." "apellidos" => "Santos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M.P." "apellidos" => "Barbosa" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Immunoallergology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculty of Medicine, University of Lisbon, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1336 "Ancho" => 1523 "Tamanyo" => 60152 ] ] "descripcion" => array:1 [ "en" => "Boxplots of visual analogue scales (VAS) scores for pain and fear." ] ] ] "textoCompleto" => "Allergic respiratory diseases are usually treated with anti-inflammatory and/or anti-symptomatic drugs. However, not all patients are satisfied with pharmacotherapy even when drugs are provided free of charge.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Subcutaneous immunotherapy (SCIT) has disease-modifying effects,<a class="elsevierStyleCrossRef" href="#bib0010">2</a> and constitutes a cost-effective treatment of allergic asthma and/or rhinitis.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> It has some disadvantages, such as the need for injections, monthly visits to allergy centres, and the possibility of local and/or systemic reactions, some of which may be severe. Although there are several studies evaluating children's pain associated with immunisation procedures, as far as we know there are no children or adult studies evaluating pain or fear associated with subcutaneous immunotherapy injections. In the present study we tried to assess if adult patients undergoing injective immunotherapy felt that allergy injections were painful or dangerous, using visual analogue scales (VAS), which are simple validated tools widely used to measure subjective aspects,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> such as the level of pain or fear associated with some procedures.We applied an anonymous questionnaire to all adult patients with respiratory allergy (asthma and/or rhinitis) that received a maintenance allergy shot with polymerised aeroallergen extracts in our department during the month of May 2010. Apart from the oral information that had been previously given by their attendant allergologists, all patients received, at the time of their first injections, written information concerning possible local and systemic reactions, being expressly advised that they should receive their allergy shots in a hospital setting because of the risk of important immediate side-effects that could be life-threatening.We excluded patients in the build-up phase of SCIT because we are now currently using, for patients’ convenience, a rush build-up scheme with two injections of polymerised extracts, performed on the same day with a 30–60min interval, allowing to reach the maintenance dose on that same day. As it did not seem correct to compare days with two injections with days with only one injection, we chose to assess only patients receiving one maintenance injection (always 0.5ml also to avoid bias of different volumes injected). Additionally, these patients already had some personal experience with the procedure, which was felt as an advantage to obtain a sound judgement. However, it can be reasonably argued that this inclusion criterion could have created a selection bias favouring the inclusion of patients who for any reason are compliant with SCIT or selecting those patients who have overcome their fear or pain associated with SCIT.The questionnaire was handed to the patient by the nurse, immediately after the injection, and was collected 30min later, when the patient was re-evaluated before hospital discharge. The questionnaire comprised demographic (age, sex) and clinical data (year of SCIT initiation, presence of asthma and/or rhinitis) and two 100mm VAS regarding intensity of pain, varying from 0 (no pain) to 100 (worst pain possible) and regarding apprehension/fear towards the allergy shots, varying from 0 (no apprehension/fear) to 100 (highest degree of apprehension/fear). The score was determined by the distance in millimetres from the starting point on the left end of the line up to the point marked by the patient.During this one-month study, 292 patients received an allergy shot in our department. We excluded 82 patients: 14 patients refused to participate; 46 patients were in the build-up phase; and 22 patients incorrectly fulfilled one or both VAS. Therefore we were able to analyse a total of 210 questionnaires (56% females). Patients’ mean age was 32.4±11.7 years (median 30 years; minimum 19; maximum 65 years). Most patients were in the first or second year of SCIT (mean SCIT duration 1.2±1.3 years; minimum 4 months, maximum 5 years). Both VAS data are presented in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. Mean value for pain was 9.5mm (minimum 0; median 0; 3rd quartile 19; maximum 40mm). Fifty-three percent of our patients had a VAS pain score of zero. Mean value for VAS fear was 1.7mm (minimum 0; median 0; 3rd quartile 0; maximum 30mm). Eighty-nine percent of our patients had a VAS fear score of zero. Fear and pain VAS scores were weakly correlated (r=0.22; p=0.03; Pearson). Females scored slightly higher on pain VAS (mean 11.4mm in females versus 7.2mm in males; p=0.032; chi-square) but both sexes scored equally on fear VAS. Age, type of allergens (mites or pollens) and type of allergic disease (asthma, rhinitis or both) had no statistically significant influence on pain or fear VAS scores. However, longer SCIT duration was associated with small, although statistically non-significant, increases in pain VAS score but not on fear VAS score (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). As reported in other studies we have observed a progressive reduction in the number of patients that continue regular SCIT-treatment throughout time, this reduction being particularly more marked after the second year of SCIT.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The results of this study clearly suggest that allergy shots are associated with low or absent levels of fear or pain, as self-reported by allergic patients, despite the fact that some physicians and non SCIT-treated patients may believe otherwise. Pain is a multidimensional experience involving a wide spectrum of affective and emotional factors. The concept of pain varies from person to person; nevertheless it can be defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Quantification of pain through VAS scores has allowed comparisons between different settings and between different individuals. In studies of postoperative pain, VAS scores of 0–4mm are generally considered as representing no pain and between 5 and 44mm to represent mild or acceptable pain.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Studies in diverse settings have proposed mild pain to be defined up to 36–50mm in pain VAS,<a class="elsevierStyleCrossRef" href="#bib0035">7</a> while a very recent clinical trial in headache patients defined, by analysis of ROC curves, the following cut-off points for VAS scores: no pain 0–2mm; mild pain 2–17mm; moderate pain 17–47mm; severe pain 47–77mm; very severe pain 77–96mm; and the most severe pain imaginable 96–100mm.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> In our study, all patients scored less than 40mm, 53% scored zero and 75% scored 19 or less. This means that the perception of pain or perception of potential damage associated with allergy injections is not a very important issue in the majority of adult patients on maintenance SCIT with polymerised allergen vaccines, at least when injections are given by trained staff in a hospital setting. There is a slightly higher perception of pain by female patients, something that has already been reported in other pain studies.<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a> In our study, asthmatic patients had VAS pain scores very similar to rhinitis patients (9.3mm versus 9.7mm), without any significant differences. However it was not possible to evaluate the subgroup of asthmatic patients who had already been treated in an emergency department (and who could have previously had other painful experiences with injections) since no question regarding prior emergency room treatments was included in our questionnaire. The slight (but not significant) increase in pain scores that is seen with the increase in SCIT duration could perhaps be attributed to repeated local trauma but since we did not investigate prospectively the evolution of pain scores in the same individuals we have no data to support this assumption.Fear associated with allergy shots is even more multifactorial. It probably comprises, among other dimensions, fear of immediate pain due to injection, fear of local reactions (painful or troublesome) or even fear of severe reactions (needing treatment, hospitalisation or potentially life-threatening). Obviously fear scores are influenced by previous experiences and also by the information that people have (perceived risk). In our study, despite all patients having received oral and written information regarding the potential risks of allergen vaccines, it is worth mentioning that 89% of patients stated no fear regarding allergy shots, demonstrating once again, at least in experienced centres, that the perceived risk of severe adverse reactions to allergy shots is not a major issue for most of our patients in maintenance SCIT with polymerised allergen vaccines.In conclusion, in this study we found that most allergic patients receiving regular maintenance allergy shots with polymerised allergen vaccines in a specialised immunoallergology centre do not perceive this form of treatment as painful or dangerous. These results highlight the fact that most of these patients do not report any negative views towards the application of immunotherapy via subcutaneous injections.Ethical disclosureProtection of human and animal subjects. The authors declare that no experiments were performed on humans or animals for this investigation.Right to privacy and informed consent. The authors declare that no patient data appears in this article.Confidentiality of data. The authors declare that no patient data appears in this article." "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical disclosure" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1336 "Ancho" => 1523 "Tamanyo" => 60152 ] ] "descripcion" => array:1 [ "en" => "Boxplots of visual analogue scales (VAS) scores for pain and fear." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "VAS – visual analogue scales, SCIT – subcutaneous immunotherapy; SD – standard deviation." 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Gereda-Solari" 1 => "J. Loo" 2 => "A. Felices" 3 => "J. Casas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Allergol Immunopathol" "fecha" => "2006" "volumen" => "34" "paginaInicial" => "102" "paginaFinal" => "106" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term clinical and immunological effects of allergen immunotherapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.Q. Eifan" 1 => "M.H. Shamji" 2 => "S.R. 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Research letter

Allergy shots: Do patients feel pain or fear?

M.B. Ferreiraa,b,

Corresponding author

mbrancoferreira@gmail.com

Corresponding author.

, L.P. Viegasa, A.S. Santosa, M.P. Barbosaa,b

a Immunoallergology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Portugal

b Faculty of Medicine, University of Lisbon, Portugal

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    "titulo" => "Allergy shots&#58; Do patients feel pain or fear&#63;"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Boxplots of visual analogue scales &#40;VAS&#41; scores for pain and fear&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Allergic respiratory diseases are usually treated with anti-inflammatory and&#47;or anti-symptomatic drugs&#46; However&#44; not all patients are satisfied with pharmacotherapy even when drugs are provided free of charge&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Subcutaneous immunotherapy &#40;SCIT&#41; has disease-modifying effects&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and constitutes a cost-effective treatment of allergic asthma and&#47;or rhinitis&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It has some disadvantages&#44; such as the need for injections&#44; monthly visits to allergy centres&#44; and the possibility of local and&#47;or systemic reactions&#44; some of which may be severe&#46; Although there are several studies evaluating children&#39;s pain associated with immunisation procedures&#44; as far as we know there are no children or adult studies evaluating pain or fear associated with subcutaneous immunotherapy injections&#46; In the present study we tried to assess if adult patients undergoing injective immunotherapy felt that allergy injections were painful or dangerous&#44; using visual analogue scales &#40;VAS&#41;&#44; which are simple validated tools widely used to measure subjective aspects&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> such as the level of pain or fear associated with some procedures&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We applied an anonymous questionnaire to all adult patients with respiratory allergy &#40;asthma and&#47;or rhinitis&#41; that received a maintenance allergy shot with polymerised aeroallergen extracts in our department during the month of May 2010&#46; Apart from the oral information that had been previously given by their attendant allergologists&#44; all patients received&#44; at the time of their first injections&#44; written information concerning possible local and systemic reactions&#44; being expressly advised that they should receive their allergy shots in a hospital setting because of the risk of important immediate side-effects that could be life-threatening&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We excluded patients in the build-up phase of SCIT because we are now currently using&#44; for patients&#8217; convenience&#44; a rush build-up scheme with two injections of polymerised extracts&#44; performed on the same day with a 30&#8211;60<span class="elsevierStyleHsp" style=""></span>min interval&#44; allowing to reach the maintenance dose on that same day&#46; As it did not seem correct to compare days with two injections with days with only one injection&#44; we chose to assess only patients receiving one maintenance injection &#40;always 0&#46;5<span class="elsevierStyleHsp" style=""></span>ml also to avoid bias of different volumes injected&#41;&#46; Additionally&#44; these patients already had some personal experience with the procedure&#44; which was felt as an advantage to obtain a sound judgement&#46; However&#44; it can be reasonably argued that this inclusion criterion could have created a selection bias favouring the inclusion of patients who for any reason are compliant with SCIT or selecting those patients who have overcome their fear or pain associated with SCIT&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The questionnaire was handed to the patient by the nurse&#44; immediately after the injection&#44; and was collected 30<span class="elsevierStyleHsp" style=""></span>min later&#44; when the patient was re-evaluated before hospital discharge&#46; The questionnaire comprised demographic &#40;age&#44; sex&#41; and clinical data &#40;year of SCIT initiation&#44; presence of asthma and&#47;or rhinitis&#41; and two 100<span class="elsevierStyleHsp" style=""></span>mm VAS regarding intensity of pain&#44; varying from 0 &#40;no pain&#41; to 100 &#40;worst pain possible&#41; and regarding apprehension&#47;fear towards the allergy shots&#44; varying from 0 &#40;no apprehension&#47;fear&#41; to 100 &#40;highest degree of apprehension&#47;fear&#41;&#46; The score was determined by the distance in millimetres from the starting point on the left end of the line up to the point marked by the patient&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">During this one-month study&#44; 292 patients received an allergy shot in our department&#46; We excluded 82 patients&#58; 14 patients refused to participate&#59; 46 patients were in the build-up phase&#59; and 22 patients incorrectly fulfilled one or both VAS&#46; Therefore we were able to analyse a total of 210 questionnaires &#40;56&#37; females&#41;&#46; Patients&#8217; mean age was 32&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;7 years &#40;median 30 years&#59; minimum 19&#59; maximum 65 years&#41;&#46; Most patients were in the first or second year of SCIT &#40;mean SCIT duration 1&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;3 years&#59; minimum 4 months&#44; maximum 5 years&#41;&#46; Both VAS data are presented in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; Mean value for pain was 9&#46;5<span class="elsevierStyleHsp" style=""></span>mm &#40;minimum 0&#59; median 0&#59; 3rd quartile 19&#59; maximum 40<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Fifty-three percent of our patients had a VAS pain score of zero&#46; Mean value for VAS fear was 1&#46;7<span class="elsevierStyleHsp" style=""></span>mm &#40;minimum 0&#59; median 0&#59; 3rd quartile 0&#59; maximum 30<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Eighty-nine percent of our patients had a VAS fear score of zero&#46; Fear and pain VAS scores were weakly correlated &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;22&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;03&#59; Pearson&#41;&#46; Females scored slightly higher on pain VAS &#40;mean 11&#46;4<span class="elsevierStyleHsp" style=""></span>mm in females versus 7&#46;2<span class="elsevierStyleHsp" style=""></span>mm in males&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;032&#59; chi-square&#41; but both sexes scored equally on fear VAS&#46; Age&#44; type of allergens &#40;mites or pollens&#41; and type of allergic disease &#40;asthma&#44; rhinitis or both&#41; had no statistically significant influence on pain or fear VAS scores&#46; However&#44; longer SCIT duration was associated with small&#44; although statistically non-significant&#44; increases in pain VAS score but not on fear VAS score &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; As reported in other studies we have observed a progressive reduction in the number of patients that continue regular SCIT-treatment throughout time&#44; this reduction being particularly more marked after the second year of SCIT&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The results of this study clearly suggest that allergy shots are associated with low or absent levels of fear or pain&#44; as self-reported by allergic patients&#44; despite the fact that some physicians and non SCIT-treated patients may believe otherwise&#46; Pain is a multidimensional experience involving a wide spectrum of affective and emotional factors&#46; The concept of pain varies from person to person&#59; nevertheless it can be defined as &#8220;an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Quantification of pain through VAS scores has allowed comparisons between different settings and between different individuals&#46; In studies of postoperative pain&#44; VAS scores of 0&#8211;4<span class="elsevierStyleHsp" style=""></span>mm are generally considered as representing no pain and between 5 and 44<span class="elsevierStyleHsp" style=""></span>mm to represent mild or acceptable pain&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Studies in diverse settings have proposed mild pain to be defined up to 36&#8211;50<span class="elsevierStyleHsp" style=""></span>mm in pain VAS&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> while a very recent clinical trial in headache patients defined&#44; by analysis of ROC curves&#44; the following cut-off points for VAS scores&#58; no pain 0&#8211;2<span class="elsevierStyleHsp" style=""></span>mm&#59; mild pain 2&#8211;17<span class="elsevierStyleHsp" style=""></span>mm&#59; moderate pain 17&#8211;47<span class="elsevierStyleHsp" style=""></span>mm&#59; severe pain 47&#8211;77<span class="elsevierStyleHsp" style=""></span>mm&#59; very severe pain 77&#8211;96<span class="elsevierStyleHsp" style=""></span>mm&#59; and the most severe pain imaginable 96&#8211;100<span class="elsevierStyleHsp" style=""></span>mm&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In our study&#44; all patients scored less than 40<span class="elsevierStyleHsp" style=""></span>mm&#44; 53&#37; scored zero and 75&#37; scored 19 or less&#46; This means that the perception of pain or perception of potential damage associated with allergy injections is not a very important issue in the majority of adult patients on maintenance SCIT with polymerised allergen vaccines&#44; at least when injections are given by trained staff in a hospital setting&#46; There is a slightly higher perception of pain by female patients&#44; something that has already been reported in other pain studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> In our study&#44; asthmatic patients had VAS pain scores very similar to rhinitis patients &#40;9&#46;3<span class="elsevierStyleHsp" style=""></span>mm versus 9&#46;7<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; without any significant differences&#46; However it was not possible to evaluate the subgroup of asthmatic patients who had already been treated in an emergency department &#40;and who could have previously had other painful experiences with injections&#41; since no question regarding prior emergency room treatments was included in our questionnaire&#46; The slight &#40;but not significant&#41; increase in pain scores that is seen with the increase in SCIT duration could perhaps be attributed to repeated local trauma but since we did not investigate prospectively the evolution of pain scores in the same individuals we have no data to support this assumption&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Fear associated with allergy shots is even more multifactorial&#46; It probably comprises&#44; among other dimensions&#44; fear of immediate pain due to injection&#44; fear of local reactions &#40;painful or troublesome&#41; or even fear of severe reactions &#40;needing treatment&#44; hospitalisation or potentially life-threatening&#41;&#46; Obviously fear scores are influenced by previous experiences and also by the information that people have &#40;perceived risk&#41;&#46; In our study&#44; despite all patients having received oral and written information regarding the potential risks of allergen vaccines&#44; it is worth mentioning that 89&#37; of patients stated no fear regarding allergy shots&#44; demonstrating once again&#44; at least in experienced centres&#44; that the perceived risk of severe adverse reactions to allergy shots is not a major issue for most of our patients in maintenance SCIT with polymerised allergen vaccines&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; in this study we found that most allergic patients receiving regular maintenance allergy shots with polymerised allergen vaccines in a specialised immunoallergology centre do not perceive this form of treatment as painful or dangerous&#46; These results highlight the fact that most of these patients do not report any negative views towards the application of immunotherapy via subcutaneous injections&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosure</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Protection of human and animal subjects&#46;</span> The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Right to privacy and informed consent&#46;</span> The authors declare that no patient data appears in this article&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Confidentiality of data&#46;</span> The authors declare that no patient data appears in this article&#46;</p></span></span>"
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Article information

ISSN: 03010546
Original language: English

DOI:10.1016/j.aller.2012.02.004

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Year/Month	Html	Pdf	Total

2024 November	12	2	14
2024 October	119	17	136
2024 September	142	26	168
2024 August	91	15	106
2024 July	114	12	126
2024 June	99	6	105
2024 May	117	13	130
2024 April	62	7	69
2024 March	89	11	100
2024 February	81	8	89
2024 January	91	12	103
2023 December	65	10	75
2023 November	85	11	96
2023 October	94	8	102
2023 September	43	8	51
2023 August	37	11	48
2023 July	49	10	59
2023 June	66	6	72
2023 May	52	8	60
2023 April	51	1	52
2023 March	42	4	46
2023 February	33	5	38
2023 January	21	6	27
2022 December	9	9	18
2022 November	27	12	39
2022 October	15	15	30
2022 September	20	7	27
2022 August	15	13	28
2022 July	17	10	27
2022 June	16	9	25
2022 May	24	8	32
2022 April	12	8	20
2022 March	19	6	25
2022 February	9	9	18
2022 January	16	4	20
2021 December	6	9	15
2021 November	11	17	28
2021 October	7	16	23
2021 September	11	11	22
2021 August	8	10	18
2021 July	7	6	13
2021 June	12	13	25
2021 May	11	13	24
2021 April	9	6	15
2021 March	14	14	28
2021 February	8	5	13
2021 January	8	9	17
2020 November	0	2	2
2020 September	0	1	1
2020 August	0	1	1
2020 July	0	2	2
2020 May	0	3	3
2020 April	0	1	1
2020 March	0	4	4
2020 February	0	7	7
2020 January	0	3	3
2019 December	0	3	3
2019 November	0	1	1
2019 August	0	2	2
2019 July	0	11	11
2019 June	0	11	11
2019 May	0	29	29
2019 April	0	9	9
2019 March	0	2	2
2019 February	0	2	2
2019 January	0	9	9
2018 April	0	2	2
2018 March	1	0	1
2018 February	49	1	50
2018 January	4	3	7
2017 December	53	2	55
2017 November	10	3	13
2017 October	3	6	9
2017 September	7	9	16
2017 August	6	7	13
2017 July	8	11	19
2017 June	9	12	21
2017 May	11	8	19
2017 April	15	11	26
2017 March	12	2	14
2017 February	14	7	21
2017 January	9	8	17
2016 December	18	13	31
2016 November	8	6	14
2016 October	31	11	42
2016 September	20	9	29
2016 August	11	9	20
2016 July	6	1	7
2016 June	17	5	22
2016 May	12	8	20
2016 April	17	12	29
2016 March	18	14	32
2016 February	10	17	27
2016 January	12	16	28
2015 December	9	10	19
2015 November	17	25	42
2015 October	20	14	34
2015 September	17	9	26
2015 August	9	3	12
2015 July	3	5	8
2015 June	7	0	7
2015 May	6	4	10
2015 April	5	8	13
2015 March	8	9	17
2015 February	7	1	8
2015 January	15	2	17
2014 December	17	7	24
2014 November	12	4	16
2014 October	17	8	25
2014 September	27	3	30
2014 August	15	1	16
2014 July	12	6	18
2014 May	1	0	1
2014 April	1	2	3
2014 March	23	6	29
2014 February	31	8	39
2014 January	18	9	27
2013 December	21	7	28
2013 November	20	10	30
2013 October	16	13	29
2013 September	31	13	44
2013 August	20	9	29
2013 July	7	6	13

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Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

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