[Standardized rapid hyposensitization with purified hymenoptera venom in wasp venom allergy. Prospective study of development of tolerance and side-effect profile].
In Germany, insect allergies cause about 10-40 death per year. Starting a specific immunotherapy (SIT) and its maintenance may be lifesaving for the allergic patients. Performing a prospective study, we exactly documented effects and side effects during the induction phase of SIT using a purified aqueous yellow jacket venom preparation in 20 patients allergic to yellow jacket venom (clinical degree II-IV). Indication for the therapy was defined individually for each patient and was based on a score incorporating the following criteria: a) clinical symptoms, b) in-vivo- and in-vitro testing, c) risk of re-sting. SIT was started under inpatient conditions following a standardized 8 day protocol. At the end of the induction phase all patients tolerated the maintenance dose of 100 micrograms of yellow jacket venom without complications even though all showed local side effects (threshold doses 0.01-10 micrograms, median value 0.2 microgram). 40% of all patients showed subjective side effects (median value of threshold dose 30 micrograms, range 0.2-60 micrograms) and 30% showed objective side effects (median value of threshold dose 55 micrograms, range 20-80 micrograms); however, all side effects were clinically mild. When objective systemic side effects were seen, the cumulative daily dose was 39-210 micrograms (median value 135 micrograms), exceeding 100 micrograms in 83% of patients. Our prospective study confirmed that the chosen protocol for SIT is effective in inducing tolerance to the venom preparation. However, using a purified aqueous yellow jacket preparation did not result in reduction of side effects.
Treudler
R
R
Universitäts-Hautklinik und Poliklinik, Freien Universität Berlin.
Tebbe
B
B
Orfanos
C E
CE
D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000276:immunology* / Q000517:prevention & control; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007299:Insect Bites and Stings / Q000276:immunology*; D007428:Intradermal Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014862:Wasp Venoms / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology*
D014862:Wasp Venoms