Related Experiment Video
Updated: Feb 26, 2026
Basophil Activation Test for Allergy Diagnosis
Published on: May 31, 2021
Safety of 100 µg venom immunotherapy rush protocols in children compared to adults
Johanna Stoevesandt1, Christine Hosp1, Andreas Kerstan1
1Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Josef-Schneider-Straße 2, 97080 Würzburg, Germany.
Insights
Venom immunotherapy (VIT) in children showed a higher rate of anaphylactic reactions compared to adults, primarily linked to bee venom allergies. However, these reactions were generally mild and did not impede treatment completion.
Area of Science:
- Allergy and Immunology
- Pediatric Medicine
- Clinical Toxicology
Background:
- Limited research exists on the safety of venom immunotherapy (VIT) in pediatric populations.
- Assessing anaphylactic side effects during rush VIT in children is crucial.
Purpose of the Study:
- To evaluate the incidence of anaphylactic side effects during rush venom immunotherapy (VIT) in pediatric patients.
- To compare the safety profile of VIT in children versus adult controls.
Main Methods:
- Retrospective evaluation of 72 VIT-buildup cycles in 71 children/adolescents (aged 7-17 years).
- Comparison with 981 adult controls, analyzing baseline parameters and anaphylactic reaction rates.
- Statistical analysis including univariate and binary logistic regression.
Main Results:
- Children experienced less severe index sting anaphylaxis but had a higher overall rate of VIT-induced anaphylactic reactions (6.9% vs 2.5%).
- Bee venom allergy and 5-day buildup protocols were associated with increased risk of anaphylaxis in children.
- Despite higher reaction rates, all pediatric patients tolerated the maintenance dose.
Conclusions:
- The increased anaphylactic reaction rate in children is likely due to a higher prevalence of bee venom allergy.
- VIT-induced anaphylaxis in children is typically mild and does not hinder treatment progression.
- Rush VIT is a viable treatment option for pediatric patients with venom allergies.
Background:
There is a paucity of studies examining the safety of venom immunotherapy (VIT) in children. We aimed to assess the incidence of anaphylactic side effects during rush VIT in a cohort of pediatric patients and adult controls.
Methods:
72 consecutive cycles of VIT-buildup in 71 children/adolescents aged 7-17 years were retrospectively evaluated and compared to an adult control group (n = 981) with regard to baseline parameters (sex, causative venom, severity of index sting reaction, results of allergy testing, comorbidities) and the incidence of anaphylactic adverse reactions.
Results:
Compared to adults, severe index sting-induced anaphylaxis was significantly less common in children (P = .001). Children were more likely to suffer from bee venom allergy (P < .001) and showed higher levels of bee venom-specific IgE (P = .013), but lower serum tryptase concentrations (P = .014). The overall rate of VIT-induced anaphylactic reactions was higher in children than in adults (6.9% vs 2.5%, P = .046 by univariate analysis). In the final binary logistic regression model, however, only bee VIT (P = .039; odds ratio 2.25; confidence interval 1.04-4.87) and 5-day compared to 3-day buildup protocols (P = .011; odds ratio 2.64; confidence interval 1.25-5.57) were associated with an increased risk of treatment-induced anaphylaxis. All pediatric patients finally reached and tolerated the target maintenance dose of 100 µg.
Conclusions:
The higher anaphylactic reaction rate observed in pediatric patients may be attributed to a greater prevalence of bee venom allergy. VIT-induced anaphylaxis in children is usually mild and does not affect further updosing and maintenance of VIT.
Related Concept Videos
01:29Drug Dosing: Infants and Children
01:30Allergic Reactions: Anaphylaxis
02:06Allergic Reactions
01:30Drug Toxicity: Allergic Reactions
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption