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Systemic reactions during maintenance immunotherapy with honey bee venom
J Bousquet1, J L Ménardo, G Velasquez
1Clinique des Maladies Respiratories, Centre Hospitalier Universitaire, Montepillier, France.
Annals of Allergy
|July 1, 1988
Summary
Hymenoptera venom immunotherapy can fail, causing anaphylaxis or re-sensitization. A rush protocol with honey bee venom (HBV) effectively protected patients, especially when preceded by local reactions or increased IgE.
Area of Science:
- Allergy and Immunology
- Toxicology
Background:
- Hymenoptera venom immunotherapy (VIT) is a standard treatment for stinging insect allergies.
- While generally safe and effective, treatment failures can occur, necessitating further investigation.
Observation:
- Five patients undergoing maintenance honey bee venom (HBV) immunotherapy experienced systemic anaphylaxis.
- Reactions included severe, life-threatening events upon bee sting, and new clinical sensitivities (re-sensitization) in three patients, one following a viral infection.
Findings:
- Predictive signs included large local reactions before systemic events, increased skin test reactivity, and elevated serum HBV-specific IgE.
- Serum HBV-specific IgG levels were below 200 U/mL in all affected patients.
Implications:
- A modified rush immunotherapy protocol with monthly doses (200-400 micrograms) of HBV proved effective in re-establishing protection.
- Identifying predictive markers like local reactions and IgE levels can help anticipate and manage treatment failures in VIT.