EAACI Guidelines on Allergen Immunotherapy: Hymenoptera venom allergy (original) (raw)
Related papers
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
Allergo Journal International, 2020
Purpose Stings by Hymenoptera usually cause just local reactions. However, in some cases, they can induce systemic symptoms and even fatal reactions. The natural history and the risk factors of severe systemic reactions are presented in this review. Methods Both the natural history and risk factors of systemic reactions due to insect stings are unraveled. This publication is based on a selective literature search in PubMed, Web of Science, and EMBASE (until 30 July 2019). Recent publications about insect venom allergy in English journals were analyzed. This literature search included original and review articles and relevant abstracts of allergy congresses in English. Results Risk factors are classified as follows: (1) patient-related, (2) allergen-related and (3) reactionrelated and also risk factor associated to venom immunotherapy (VIT) are considered. Due to the scarcity of data about the suitability of premedication before and during VIT, a succinct table gathering available premedication invites further investigation. Conclusions There is limited evidence with regard to the natural history of HVA both in adults and in chil
Hymenoptera Venom Allergy: Management of Children and Adults in Clinical Practice
Journal of Investigational Allergology and Clinical Immunology, 2019
Hymenoptera venom allergy is an epidemiologically underestimated condition and a major cause of morbidity worldwide. Preventing future allergic reactions in patients who experience a systemic reaction is based on the correct management of the emergency followed by an accurate diagnosis, prescription of adrenaline autoinjectors, and, where indicated, specific venom immunotherapy. Some epidemiological studies highlight our poor knowledge of this disease and the frequent inadequacy of its management. Moreover, they emphasize the importance of such a life-saving treatment as specific immunotherapy. The availability of high-quality hymenoptera venom extracts for diagnostic and therapeutic use has dramatically improved the prognosis and quality of life of allergic patients. Subcutaneous venom immunotherapy is currently the most effective form of allergen-based immunotherapy, with a carry-over effect lasting up to several years after its interruption. This report on the management of hymenoptera venom-allergic children and adults was prepared by a panel of Italian experts. The main objective of this consensus document is to review the scientific evidence related to diagnosis, therapy, and management of patients allergic to hymenoptera venom. Thus, we can improve our knowledge of the disease and promote good clinical practices. The present document provides practical suggestions for correct diagnosis, prescription of emergency therapy and immunotherapy, and strategies for patient care.
Hymenoptera venom allergy: Taking the sting out of difficult cases
Journal of investigational allergology & clinical immunology: official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología
Background: Correct identifi cation of the culprit venom is a prerequisite for specifi c venom immunotherapy. Objective: To assess whether the basophil activation test (BAT) constitutes an additional diagnostic instrument in patients with equivocal or negative specifi c immunoglobulin (Ig) E or venom skin test (VST) results. Methods: One hundred eighteen patients with a compelling history of IgE-mediated hymenoptera venom allergy were enrolled. Venomspecifi c IgE was quantifi ed by ImmunoCAP and VST was performed in all patients. Basophil activation was analyzed by fl ow cytometry after labeling with anti-IgE and anti-CD63. Results: In 64 out of 118 patients, diagnosis was considered as defi nite and the entomologic description was confi rmed by unequivocal and concordant positive specifi c IgE and VST results. In 53 of those 64 patients, BAT confi rmed diagnosis, whereas the remaining 11 patients were nonresponsive in the BAT analysis. Forty-seven patients (40%) had a tentative diagnosis of venom allergy, as they had divergent specifi c IgE or VST results. In 31 of those patients, BAT was positive only for the suspected venom and helped to establish diagnosis of wasp and honeybee venom allergy in 28 and 3 patients, respectively. BAT was diagnostic in 7 patients with complete negative results for specifi c IgE and VST, despite clear entomologic identifi cation. Conclusions: In about half the patients with diagnosis of venom allergy, unequivocal specifi c IgE and VST results are obtained and additional tests are not needed. In the remainder, diagnosis is less straightforward due to discrepant or negative specifi c IgE or VST results. In these patients, BAT constitutes a helpful additional instrument to identify the culprit venom and start venom immunotherapy accordingly.
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 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.