Further observations of stopping venom immunotherapy: comparison of patients stopped because of a fall in serum venom-specific IgE to insignificant levels with patients stopped prematurely by self-choice.
This study extends our experience applying the criterion of a fall in serum venom-specific IgE (RAST) to insignificant levels as an indication to stop venom immunotherapy (VIT) and compares the follow-up results with the results of re-stings in patients who stopped VIT "prematurely" by self-choice. All patients in both groups had a history of venom anaphylaxis, most with cardiovascular and/or respiratory symptoms and initial elevated serum venom-specific IgE; all patients received VIT. The groups were closely matched for age, sex, nature of initial sting reaction, and insect identification. In the group with low-level RAST titers, the duration of VIT was 6 months to 5 years (mean 2 1/2 years). Re-stings occurred from 1 month to 7 years (mean 2.2 years) after cessation of therapy. There were 75 re-stings in 41 patients with four systemic reactions (10% per patient and 5% per sting). All four reacting patients had tolerated several stings during cessation of VIT before the re-sting systemic reaction; two patients had subsequent stings with no reaction. In the group of patients who stopped VIT for other reasons, the duration of VIT was 5 months to 4 years (mean 1.8 years). Re-stings occurred from 4 months to 6 years (mean 2.1 years) after stopping therapy. There were 74 re-stings in 38 patients with seven systemic reactions in four patients (9.5% per patient and 10.5% per sting). Two of the reacting patients had tolerated stings before the re-sting reaction.(ABSTRACT TRUNCATED AT 250 WORDS)
Reisman
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Buffalo General Hospital, Department of Medicine, State University of New York, Buffalo 14203.
Lantner
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D000293:Adolescent; D000707:Anaphylaxis / Q000517:prevention & control*; D003888:Desensitization, Immunologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007073:Immunoglobulin E / Q000032:analysis*; D007299:Insect Bites and Stings / Q000150:complications / Q000276:immunology*; D008297:Male; D010349:Patient Compliance; D011852:Radioallergosorbent Test; D014688:Venoms / Q000008:administration & dosage / Q000276:immunology*
D014688:Venoms; D007073:Immunoglobulin E