Rush hymenoptera venom immunotherapy is efficacious and safe (original) (raw)
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Safety and efficacy of venom immunotherapy: a real life study
Advances in Dermatology and Allergology
Introduction: Venom immunotherapy (VIT) is recommended as the first-line treatment for patients allergic to Hymenoptera venom. Aim: To analyze the safety and efficacy of VIT in a real life setting. Material and methods: One hundred and eighty patients undergoing VIT were studied to evaluate the safety, efficacy, incidence and nature of symptoms after field stings and adverse reactions to VIT. Results: Significantly more patients were allergic to wasp than bee venom (146 vs. 34, p < 0.0001). Early and late side effects were more common during the maintenance (48 patients, 26.7%) than during the induction of VIT (32 patients, 17.8%), were more frequent in patients allergic to bees, and were not associated with angiotensin convertase inhibitors (ACEi) or β-adrenergic antagonists use. Systemic reactions were observed in 4 individuals on wasp VIT (2.7%) and in 6 patients allergic to bees (17.65%). The VIT was efficacious as most patients reported no reactions (50%) or reported only mild local reactions (43.75%) to field stings. The decrease in sIgE at completion of VIT correlated with the dose of vaccine received (r = 0.53, p = 0.004). Beekeeping (RR = 29.54, p < 0.0001) and female sex (RR = 1.27, p = 0.033) were associated with a higher risk of venom allergy. Conclusions: Venom immunotherapy is highly efficacious and safe as most of the adverse events during the induction and maintenance phase are mild and local. Side effects of VIT are more common in subjects on bee VIT. Beekeeping and female sex are associated with a higher risk of allergy to Hymenoptera venom.
A simple 3-day “rush” venom immunotherapy protocol: documentation of safety
Allergologia Et Immunopathologia, 2010
Background: Venom immunotherapy (VIT) is the only effective treatment for hymenoptera hypersensitivity, but conventional protocols require a few weeks. Objective: We present the safety of a 3-day ''rush'' protocol that requires only 7 injections and 255 mgr cumulative dose before the 100 mg maintenance dose. Methods: Forty-nine patients (33 males, 16 females) of mean age 43.57712.9yrs received ''rush'' VIT. Only 7 injections were required until the maintenance dose of 100 mgr was reached on Day 5. On Day 1, four injections were administered with initial dose of 5 mgr and total dose of 75 mg. On Day 3 a cumulative dose of 180 mgr was administered in three injections (40 mgr, 60 mgr and 80 mgr). A dose of 100 mgr was administered on Day 5. Twenty-nine individuals were treated with Honey-Bee venom; 18 with Common wasp; 5 with Paper Wasp; while 13 patients received Mixed Vespid preparation. Inclusion criteria were documented IgE-mediated allergy with intradermal sensitivity to r0.1 mgr/ml venom concentration and concomitant detection of specific venom IgE Z0.35 kU/l. Results: All patients reached the maintenance dose. Forty-nine patients received 65 immunotherapy courses, resulting in 1520 injections. Thirty-three systemic reactions: 7 during building phase (1.5%); and 26 in the maintenance dose (2.4%) were observed in 9 patients. The percentage of reactions/total injection number was 2.2%; all reactions were mild-to-moderate. Fourteen patients reported documented field stings at least two months after VIT onset with only one reported mild systemic reaction. (M. Makris).
Field sting reactions in patients receiving Hymenoptera venom immunotherapy: real-life experience
Asian Pacific Journal of Allergy and Immunology, 2022
Background: Hymenoptera stings can cause systemic allergic reactions (SARs) that are prevented by venom immunotherapy (VIT). Sting challenge tests or field stings are used to evaluate the outcome of VIT. Objective: The aim of the study was to investigate the consequences of field stings in patients during or after completion of VIT, and to identify patients at higher risk. Methods: Patients treated with VIT between 1995 and 2018 were retrospectively evaluated. Contacted patients were invited to the clinic and a questionnaire was conducted regarding the history of field stings. Results: A total of 115 patients (F/M: 45/70, mean age: 38.5 ± 12 years) treated with VIT were included; 74/115 were contacted and asked about field stings after VIT cessation. A history of 73 field stings was reported in 38 patients, 25 of whom were treated with honeybee venom and 13 with common wasp venom. Eighteen of the reactions were SARs [8 with honeybees (1 grade-I, 6 grade-II, 1 grade-III) and 10 with common wasps (1 grade-I, 5 grade-II, 4 grade-III)]. There was no association between the severity of index reactions and field stings with either the honeybee or common wasp. The median duration of VIT was longer in patients showing no reaction than in patients with an SAR. Of the 7 patients on ACE inhibitors or beta-blockers, 1 asthmatic patient developed grade-II SAR due to field stings in the first year of VIT. Conclusion: This study confirms that VIT lasting at least 3 years is effective in preventing SARs after field stings.
Systemic and local reactions of bee venom immunotherapy in Iran
Iranian journal of allergy, asthma, and immunology, 2007
Severe allergic reactions during specific immunotherapy may occur in the treatment of hymenoptera sting allergy. The objective of the present study was to examine the characteristics of allergic reactions during specific immunotherapy in patients with allergy towards hymenoptera venom in the Iranian population. A prospective study was performed using the clinical reports of 27 patients with anaphylaxis to bee venom (Apis melifera, Geupes vespula and Geupes Polites). Ten patients treated with Cluster protocol during 2002 and 2006 After diagnosis of hymenoptera sting allergy according to history and intradermal tests, the patient were treated with Cluster protocol immunotherapy. The protocol lasted 6 weeks with an increase in the concentration of venom from 0.01 microg/ml to 100 microg/ml. None of the patient received premedication. All patients with hymenoptera venom allergy received 120 injections. Anaphylactic reactions were classified according to the Mueller-classification. The f...
Specific immunotherapy with hymenoptera venom
Clinical and Applied Immunology Reviews, 2001
Venom immunotherapy (VIT) is an effective treatment for most subjects who are allergic to hymenoptera venom. We have studied 22 patients (16 honey bee venom allergic and 6 vespula sp. venom allergic) subjected to immunotherapy with aqueous extract of pure venom from Allbay, Dome-Hollister-Stier. In one group of 12 patients, VIT was performed according to a rush protocol and we measured specific IgE and IgG4 during a 4-year follow-up period. We observed a decrease in specific IgE and an increase in specific IgG4 in all patients. In order to determine the safety of ultra-rush protocols (3.5 h) we have recently selected one other group of 10 patients in whom we measured tryptase release during the 24 h (at 2, 3, 4, 6, 8, 10, 12 and 24 h) after the beginning of the ultra-rush schedule. We observed no increase in adverse reactions during the induction or maintenance phase relative to rush protocols. Regarding tryptase levels, we observed no significant differences between basal and the several measurements performed during the ultra-rush VIT schedule. These results suggest that an increase in specific IgG4 is correlated with the protective effect of immunotherapy and that ultra-rush VIT is not associated with significant mast cell activation. Ultra-rush protocols are clinically safe, with a rate of systemic reactions similar to rush protocols and with less local reactions. There is no evidence of ultra-rush VIT induced mast-cell degranulation, and serum tryptase levels have not shown significant variations during ultra-rush VIT.
Journal of Allergy and Clinical Immunology, 2010
Background: Severe side effects during venom immunotherapy (VIT) are associated with a variety of risk factors. Objective: Our aim was to evaluate the association of baseline serum tryptase concentration (BTC) and of other parameters, which are routinely recorded during patient evaluation, with the frequency of severe reactions requiring an emergency intervention during the buildup phase of VIT. Methods: In this observational prospective multicenter study, we enrolled 680 patients with established honeybee or vespid venom allergy who underwent VIT. Data were collected on tryptase concentration, age, sex, culprit insect, cardiovascular medication, degree of preceding sting reaction, preventive antiallergic medication before therapy, time between last preceding sting reaction and VIT, venom specific IgE concentration, and type of buildup procedure. Relative rates were calculated with generalized additive models. Results: Fifty-seven patients (8.4%) required an emergency intervention during buildup because of a severe systemic reaction. The frequency of interventions increased significantly with higher BTC (log-linear association; adjusted odds ratio, 1.56; 95% CI, 1.15-2.11; P < .005). The predictive power of BTC was markedly greater when VIT was performed for vespid venom allergy than for bee venom (for bee VIT, no significant association; for vespid VIT, log-linear association; adjusted odds ratio, 2.33; 95% CI, 1.28-4.26; P 5 .005). The most important other factor significantly associated with severe reactions during the buildup phase of VIT was bee venom allergy. Conclusion: Before vespid VIT, measurement of baseline serum tryptase concentration should be used to identify patients with a high risk for side effects. Patients with bee venom allergy require a particularly high degree of surveillance during VIT. (J Allergy Clin Immunol 2010;126:105-11.)
Ultrarush venom desensitization after systemic reactions during conventional venom immunotherapy
Annals of Allergy, Asthma & Immunology, 2006
Background: Rush and ultrarush venom immunotherapy (VIT) protocols are safe and effective in patients with Hymenoptera hypersensitivity. However, these protocols have typically been used instead of conventional VIT and not in patients who have experienced adverse reactions during conventional VIT. To date, there are no reports of using an ultrarush VIT protocol to desensitize patients with a history of severe systemic reactions during conventional VIT. Objective: To determine whether ultrarush VIT can be safely administered to a high-risk patient with a history of severe systemic reactions to conventional VIT. Methods: Premedication with 40 mg of prednisone, 180 mg of fexofenadine, and 150 mg of ranitidine orally twice daily was initiated. The patient received VIT to mixed vespid and wasp in a medical intensive care unit via a 13-step buildup on day 1 followed by a 2-step buildup on day 2. Immunotherapy was begun with a dose of 0.005 g of mixed vespid and 0.002 g of wasp venom and achieved a total dose of 300 g of mixed vespid and 100 g of wasp venom. Results: The patient tolerated the procedure with minimal adverse effects. She subsequently received maintenance dosing in the outpatient clinic weekly for 4 weeks and bimonthly for 8 weeks, and she continues monthly maintenance VIT. Conclusions: We report the first successful use of ultrarush VIT in a high-risk patient with a history of severe systemic reactions during conventional VIT. This protocol should be considered in patients with a history of allergy to vespids or wasps who require VIT but cannot reach a maintenance dose with conventional VIT owing to systemic reactions.
Rush Hymenoptera Venom Immunotherapy in Thai Children
Journal of Allergy and Clinical Immunology, 2009
The rush hymenoptera venom immunotherapy (VIT) has been shown to be safe and effective, but it is not commonly practiced in Thailand. We examined the efficacy and safety of rush VIT and the risk factors in these patients. METHODS: A 3-year retrospective study was done which revealed 11 patients with history of severe systemic reaction after being stung by hymenoptera. Diagnosis was made on the basis of history and evidence of sensitization by positive skin testing and/or presence of specific IgE to honeybee, vespid or fire ant venom. They all received rush VIT regimen with a careful monitoring of adverse reaction in Ramathibodi hospital, a referral center for insect venom allergy. We evaluated risk factors for serious adverse reaction such as age, gender, atopic history, severity of insect sting reaction according to the H.L. Muller classification, and evidence of sensitization. RESULTS: There were 4 patients treated with honeybee, 5 with fire ant, one with mixed vespid and one with mixed vespid plus honeybee immunotherapy. All patients are male. Adverse reactions were observed in 4 patients (36%) with mild severity (1 with large local reaction, 3 with generalized urticaria but no other systemic reaction), and were not associated with age, type of hymenoptera allergen used, level of sensitization (either by skin testing or specific IgE) and atopic history. CONCLUSIONS: Rush hymenoptera venom immunotherapy is an alternative treatment for patients who are in active life styles especially children and adolescents. No serious adverse reaction with rush VITwas seen in our study.
Stinging insect allergy: current perspectives on venom immunotherapy
Journal of Asthma and Allergy, 2015
Systemic allergic reactions to insect stings affect up to 5% of the population during their lifetime, and up to 32% of beekeepers. Such reactions can be fatal, albeit very rarely, and fear of a further systemic reaction (SR) can lead to significant anxiety and quality of life impairment. A recent Cochrane systematic review confirmed that venom immunotherapy (VIT) is an effective treatment for people who have had a systemic allergic reaction to an insect sting. VIT reduces risk of a further SR (relative risk 0.10, 95% confidence interval 0.03-0.28), but VIT also reduces risk of a future large local reaction, and significantly improves disease-specific quality of life. However, health economic analysis showed that VIT is generally not cost effective for preventing future SRs; most people are stung infrequently, most SRs resolve without long-term consequences, and a fatal outcome is extremely rare. VIT only becomes cost effective if one is stung frequently (eg, beekeepers) or if quality of life improvement is considered. Thus, for most people with insect sting allergy, anxiety and quality of life impairment should be the overriding consideration when making treatment decisions, highlighting the importance of a patient-centered approach. Areas which need to be explored in future research include efforts to improve the safety and convenience of VIT such as the use of sublingual immunotherapy; quality of life effects of venom allergy in children and adolescents as well as their parents; and the optimal duration of treatment.
Specific immunotherapy in Albanian patients with anaphylaxis to hymenoptera venoms
BMC Dermatology, 2002
Background: Severe allergic reactions during rush-specific immunotherapy (Rush-SIT) may occur in the treatment of hymenoptera sting allergy. The objective of the present study was to examine the characteristics of allergic reactions during Rush-SIT in a cohort of patients with allergy towards hymenoptera venom in the mediterranean population of Albania. Methods: A retrospective study was performed using the clinical reports of 37 patients with venom of bee (apinae), wasp (vespidae, subfamily vespinae) or paperwasp (vespidae, subfamily polistinae) allergy treated with Rush-SIT between 1987 and 1996. After hymenoptera sting allergy diagnosis according to anamnesis and intracutaneous tests the patient were treated with Rush-SIT. The protocol lasted 3-4 d with an increase in the concentration from 0.01 µg/ml to 100 µg/ml. Anaphylactic reactions were classified according to the Mueller-classification. Results: The frequency of reactions during Rush-SIT for bee-venom was 4.7% and for wasp-venom was 1.5% (p < 0.01). The mean frequency of reactions of Mueller grade II for the bee-venom Rush-SIT patients during the first 4 d (= 26 injections) was 0.73 and for the wasp-venom Rush-SIT patients 0.15. No patient experienced a third-degree reaction. 94.6% of the patient supported an end dose of 100 µg. Conclusions: Rush-SIT is a reliable method for the treatment of anaphylactic reactions to hymenoptera venom even in less developed countries. Bee-venom Rush-SIT was found to cause higher numbers allergic reactions than wasp or paperwasp Rush-SIT. Background Anaphylactic reactions caused by hymenoptera stingspredominantly bee, wasp or paperwasp-stings are a common medical problem and account for approximately 40 deaths per year in the United Sates [1,2]. They belong to