Risk factors in Hymenoptera venom allergy

Area of Science:

• Allergy and Immunology
• Toxicology

Background:

• Systemic anaphylactic reactions (SAR) following Hymenoptera stings pose significant health risks.
• Venom immunotherapy (VIT) is an effective treatment, but requires careful patient selection and management due to potential risks.

Purpose of the Study:

• To identify risk factors associated with severe systemic anaphylactic reactions (SAR) after Hymenoptera stings.
• To determine risk factors for SAR during VIT and treatment failure.
• To provide guidance on optimizing VIT protocols based on identified risks.

Main Methods:

• Review of clinical data and literature on Hymenoptera sting reactions and VIT.
• Analysis of patient characteristics, sting history, and treatment parameters.
• Identification of correlations between risk factors and outcomes (SAR, treatment failure).

Main Results:

• Risk factors for SAR include prior sting severity, wasp stings, elevated baseline serum tryptase concentration (BSTC), mastocytosis, older age, ACE inhibitor use, and male gender.
• During VIT, honey bee venom treatment, high BSTC (for vespid VIT), venom-specific IgE, antihypertensive medication, and ultra-rush protocols increase SAR risk.
• Treatment failure is linked to honey bee venom allergy, high BSTC (for vespid VIT), mastocytosis, and prior VIT side effects.

Conclusions:

• Risk factor assessment is essential for personalized VIT decisions and administration.
• Minimizing risks involves managing antihypertensive medications and adjusting build-up protocols.
• Increasing maintenance doses may enhance VIT efficacy, especially in high-risk patients or those with treatment failure, with 200 µg often being sufficient.