Small Risks Big Rewards with SCIT

“This is a safe and very effective therapy, which is probably underutilized within our own community.” —Dr. Susan WassermanSubcutaneous immunotherapy (SCIT) sits in that uncomfortable space between routine and risk. It’s one of the few interventions in allergy that can actually modify disease. But it also carries a small, very real risk of severe reactions. On this episode, Dr. Susan Wasserman, professor at McMaster University and a national leader in immunotherapy, walks through what safety really looks like in practice. And where things still go wrong.Key Points:Systemic reactions are uncommon but not rareSafety has improved through better patient selection, standardized extracts, and clinic preparednessUncontrolled asthma is the most important risk factor for severe reactionsPrior systemic reactions require reassessment, especially if the cause is correctableBuild-up dosing carries higher risk than maintenanceRush and cluster protocols increase risk and need clear justificationThe 30-minute observation period captures most but not all reactionsBeta blockers and ACE inhibitors may worsen reaction severity without increasing incidenceSCIT is one of the few tools we have that can actually change the trajectory of allergic disease. But it demands discipline. Careful screening. Reliable processes. And a team that’s ready to act when things go sideways.Because most of the time, it’s safe.And the rare times it isn’t—that’s where preparation matters most.Have an idea for the show or a comment, send us a text!Visit the Canadian Society of Allergy and Clinical ImmunologyFind an allergist using our helpful toolFind Dr. Hanna on X, previously Twitter, @PedsAllergyDoc or CSACI @CSACI_caThe Allergist is produced for CSACI by PodCraft Productions