Discontinuing venom immunotherapy: extended observations
D B Golden1, K A Kwiterovich, A Kagey-Sobotka
1Johns Hopkins Asthma and Allergy Center, Baltimore, Md 21224, USA.
The Journal of Allergy and Clinical Immunology
|April 3, 1998
Summary
Discontinuing venom immunotherapy (VI) after 5-6 years carries a 5-10% risk of systemic reactions. A history of reactions during VI and persistent skin test sensitivity are key risk factors for future reactions.
Area of Science:
- Allergy and Immunology
- Clinical Medicine
- Toxicology
Background:
- Venom immunotherapy (VI) is a treatment for Hymenoptera venom allergies.
- Previous studies indicated a 5-10% residual risk of systemic reactions after discontinuing VI.
- No severe reactions occurred in 74 patients after 1-5 years off VI.
Observation:
- This study extended observations of patients discontinuing VI for 5-10 years.
- Two groups were evaluated: 74 patients from prior studies (group 1) and 51 new patients (group 2).
- Patients were surveyed for systemic reactions to field stings and venom sensitivity for 3 years after stopping VI.
Findings:
- In group 1, 11/74 patients were stung after 3-7 years off VI, with one systemic reaction (dyspnea).
- In group 2, 15/51 patients were stung, with four (26%) experiencing systemic reactions, including respiratory symptoms.
- A history of systemic reactions during VI was identified as a risk factor for reactions after discontinuation.
Implications:
- Venom immunotherapy (yellow jacket/mixed vespid) can be safely discontinued in adults after 5-6 years.
- A residual risk of 5-10% for systemic reactions exists post-discontinuation.
- Identifying patients with a history of systemic reactions during VI is crucial for risk assessment.
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