Venom immunotherapy: tolerance to a 3-day protocol of rush-immunotherapy

In the last 10 years in the Ramón y Cajal Hospital, in Madrid, we have treated 78 patients who had presented anaphylactic reactions after hymenoptera stings, by means of a rush immunotherapy protocol. Fifty patients received wasp venom and 30 received honeybee venom (2 patients were treated with both venom types). Venom immunotherapy is given to out-patients, at the hospital, in the morning. The interval between injections administered on the same day is 30 minutes and the patient stays for 2 hours under observation after the last daily dose. The schedule we use is as follows: Day 1 (0.05-1-5-10 micrograms of venom), Day 2 (20-40 micrograms), Day 3 (40-60 micrograms), Day 5 (100 micrograms). Afterwards, they receive 100 micrograms after 2 weeks and, finally, monthly. In order to achieve a better tolerance, patients are protected with antihistamines on the days they are administered the immunotherapy (mequitazine 5 mg every 12 hours) and also, doses equal or over 40 micrograms are given fractionally, injecting half dose in each arm. The percentage of systemic reactions (mild or moderate) is 13.3% for patients treated with honeybee venom and 2% for patients treated with wasp venom. These percentages are lower than those obtained with conventional protocols in which it takes several weeks to reach the maintenance dose. The speed and convenience of this protocol and also its appropriate safety have led us to use it as a routine treatment for patients who require venom immunotherapy after suffering anaphylactic reactions due to hymenoptera stings.