Management of Small Local Reaction After Allergy Injection in a 12-Year-Old
A small local reaction (<5mm red, raised bump) at the injection site after an allergy immunotherapy injection requires no specific treatment and is considered a normal, benign response that resolves spontaneously.
Assessment of Local Reaction
Local reactions to allergen immunotherapy are common and typically not concerning when small:
- Local reactions <5cm in diameter are considered mild and expected 1
- Small local reactions (like this <5mm bump) occur in approximately 13.7% of patients receiving allergen immunotherapy 1
- These reactions are classified as late and safe symptoms that resolve spontaneously or with minimal intervention 1
Management Approach
Immediate Management
- Observation only - No specific treatment is required for small local reactions <5mm
- Documentation - Record the reaction in the patient's chart for future reference
- Reassurance - Explain to the patient/parent that this is a normal, expected reaction
Optional Symptomatic Relief (if needed)
- Cool compresses may be applied to the site if desired 1
- Topical corticosteroids can be used for itching if present 1
- Oral antihistamines are rarely needed for such small reactions but may be considered if the reaction is bothersome 1
Patient Education
- Inform the patient/parent that:
- Small local reactions are common (occurring in up to 71% of patients receiving immunotherapy) 2
- These reactions are typically not bothersome (81.9% of patients find them only slightly or not bothersome) 3, 2
- Local reactions do not predict future systemic reactions 3
- Most patients (96%) would not consider stopping immunotherapy because of local reactions 2
Follow-up Considerations
No Dose Adjustment Needed
- Small local reactions (<5mm) do not require dose adjustment for future injections 1, 4
- Individual local reactions do not predict subsequent local reactions at the next injection 3
Monitoring for Future Injections
- Continue standard 30-minute observation period after future injections 1
- Document any pattern of reactions over time
Important Considerations
When to Be Concerned
- Local reactions >5cm require closer monitoring 1
- Systemic reactions (which are different from local reactions) typically occur within 30 minutes of injection but can occasionally occur later 1
- Patients should remain in the office for at least 30 minutes after each injection 1
Risk Factors to Consider
- Asthma status should be assessed before each injection (consider PEFR measurement if asthmatic) 1
- Beta-blocker medications may complicate management of any potential systemic reactions 1
This small local reaction represents a normal immune response to the allergen and does not require intervention beyond observation and reassurance.