While a number of side effects have been associated with sublingual immunotherapy, serious adverse effects are very rare (about 1.4/100000 doses), and there has not been a reported fatality. There have been a small number of reports of anaphylaxis. The majority of side effects are local and usually resolve within a few days. They include swelling of the mouth, tongue or lip, throat irritation, nausea, abdominal pain, vomiting, diarrhea, heartburn, and uvular edema. It is not yet clear if there are any risk factors that might increase a persons susceptibility to these adverse effects. Sublingual immunotherapy appears to be better tolerated than subcutaneous immunotherapy and causes fewer side effects. The safety of sublingual immunotherapy has not been studied extensively in people with chronic immunodeficiency or autoimmune disorders. Oral
Oral immunotherapy (OIT) involves feeding an allergic individual increasing amounts of a food allergen in order to raise the threshold which triggers a reaction. Long-term, many study participants still experienced mild allergic reactions or needed to regularly consume the allergen to maintain desensitivity. Additionally, oral immunotherapy is known to have an increased risk in the probability of needing epinephrine in patients who take it. Transdermal
Transdermal immunotherapy (TDIT) involves skin-induced suppression via epicutaneous (EC) application of an antigen in order to raise the threshold which triggers a reaction. Mechanism of action
In desensitization immunotherapy the aim is to induce or restore tolerance to the allergen by reducing its tendency to induce IgE production. People are desensitized through the administration of escalating doses of allergen that gradually decreases the IgE-dominated response.
Without proper treatment a permanent deformity of the finger may occur. Diagnosis
The diagnosis is generally based on symptoms and supported by X-rays. The injury can be accompanied by swelling and ecchymosis. Treatment
The management goal is to restore extension of the joint. Treatment is generally with a splint that holds the first joint of the finger straight continuously for 8 weeks. This should begin within a week of the injury. The splint may be worn just at night for a few additional weeks after this. The splint acts to immobilize flexing of the joint. Surgery generally does not improve outcomes. It may be required if the finger cannot be straightened by pushing on it or the break has pulled off more than 30% of the joint surface. Surgery may be preferred over the use of a split if a child is non-compliant. If the problem has been present a long time surgery may also be required. An open fracture may be another reason. Surgery will put the finger in a neutral position and drill a wire through the distal interphalangeal joint (DIP) to the proximal interphalangeal joint (PIP), forcing immobilization. See also
Busch fracture
Jersey finger

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