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Discontinuing venom immunotherapy.

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Discontinuing venom immunotherapy: extended observations

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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.

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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.