Use of beta-blockers during immunotherapy for Hymenoptera venom allergy.
BACKGROUND
Beta-blockers may aggravate anaphylactic reactions and interfere with treatment. There is therefore concern about their use in patients who have a history of anaphylaxis or are on allergen immunotherapy. Immunotherapy is the best available treatment for prevention of life-threatening anaphylaxis to Hymenoptera stings, which is often observed in elderly patients who have cardiovascular disease and therefore are on beta-blocker treatment.


OBJECTIVE
To analyze the risk of beta-blocker treatment during venom immunotherapy.


METHODS
We screened all 1682 patients with Hymenoptera venom allergy seen during a period of 34 months for immunotherapy, cardiovascular disease, and treatment with beta-blockers.


RESULTS
Of the 1389 patients in whom immunotherapy was recommended, 11.2% had cardiovascular disease, and 44 of these were on beta-blockers before immunotherapy. In 31 of those, the drug was replaced before starting treatment. In 3 with coronary heart disease and 1 with severe ventricular arrhythmia, the drug was continued throughout immunotherapy. In 9, it was reintroduced after reaching the maintenance dose. In an additional 12 patients, beta-blockers were newly started during immunotherapy. Of 25 patients on beta-blockers during immunotherapy, 3 (12%) developed allergic side effects, compared with 23 (16.7%) of 117 with cardiovascular disease but without beta-blockers. Systemic allergic symptoms after re-exposure by sting challenge or field sting were observed in 1 of 7 (14.3%) with and 4 of 29 (13.8%) without beta-blockade. No severe reactions to treatment or sting reexposure were observed in patients with beta-blockade.


CONCLUSIONS
Combination of beta-blockers with venom immunotherapy may be indicated in heavily exposed patients with severe cardiovascular disease.
Müller
Ulrich R
UR
Medical Department, Spital Bern Ziegler, Switzerland. ulrich.mueller@spitalbern.ch
Haeberli
Gabrielle
G
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000707:Anaphylaxis / Q000209:etiology / Q000517:prevention & control; D000818:Animals; D001514:Bee Venoms / Q000276:immunology; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D003888:Desensitization, Immunologic; D006801:Humans; D006927:Hymenoptera / Q000276:immunology; D008875:Middle Aged; D012189:Retrospective Studies
D000319:Adrenergic beta-Antagonists; D001514:Bee Venoms