Specific ultrarush desensitization in Hymenoptera venom-allergic patients.
BACKGROUND
Hymenoptera venom hypersensitivity is an epidemiologically important problem. The only effective treatment in the management of venom-allergic patients with a history of generalized reactions to insect sting is specific immunotherapy.


OBJECTIVE
To demonstrate safety and effectiveness of a modified ultrarush desensitization protocol in venom-allergic patients.


METHODS
Fifty-seven patients with Hymenoptera venom allergy underwent a specific 1-day ultrarush desensitization by the subcutaneous route, reaching the cumulative dose of 101.1 microg in 2.5 hours. The maintenance dose (100 microg) was administered after 15 days and thereafter once a month. Patients were followed up for a year. Antihistamines were withheld for 15 days before and during desensitization to not underestimate the incidence of adverse effects.


RESULTS
All patients but I completed the ultrarush desensitization. (This patient discontinued the treatment because of a hypertensive crisis not related to the desensitization.) The treatment caused a rapid variation of immunological parameters (IgE, IgG4) since the 15th day. After the desensitization, skin prick test results became negative in 15 patients (27%, decrease of 3.5 log), whereas they decreased in 14 patients (25%, decrease of 1 log). Sixty-four percent showed no adverse effects. Only 7% had a mild systemic reaction.


CONCLUSIONS
Ultrarush desensitization is an effective and safe therapy in the management of patients with Hymenoptera venom allergy. In fact, it provides a faster tolerance, without significant differences regarding incidence of severe adverse effects, compared with traditional and rush protocols. It can be adopted for all patients, even children and teenagers.
Schiavino
Domenico
D
Department of Allergology, Università Cattolica del Sacro Cuore Policlinico A. Gemelli, Rome, Italy.
Nucera
Eleonora
E
Pollastrini
Emanuela
E
De Pasquale
Tiziana
T
Buonomo
Alessandro
A
Bartolozzi
Francesco
F
Lombardo
Carla
C
Roncallo
Chiara
C
Patriarca
Giampiero
G
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000818:Animals; D000918:Antibody Specificity / Q000187:drug effects; D001514:Bee Venoms / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D003429:Cross Reactions / Q000187:drug effects; D003888:Desensitization, Immunologic / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D006927:Hymenoptera; D006969:Hypersensitivity, Immediate / Q000209:etiology* / Q000628:therapy*; D007073:Immunoglobulin E / Q000097:blood / Q000187:drug effects; D007074:Immunoglobulin G / Q000097:blood / Q000187:drug effects; D007299:Insect Bites and Stings / Q000150:complications / Q000628:therapy; D007558:Italy; D008297:Male; D008875:Middle Aged; D012882:Skin Tests; D016896:Treatment Outcome; D014862:Wasp Venoms / Q000008:administration & dosage* / Q000009:adverse effects
D000305:Adrenal Cortex Hormones; D001514:Bee Venoms; D006634:Histamine H1 Antagonists; D007074:Immunoglobulin G; D014862:Wasp Venoms; D007073:Immunoglobulin E