Flexible approaches in the design of subcutaneous immunotherapy protocols for Hymenoptera venom allergy.
BACKGROUND
Venom immunotherapy is an effective method for the treatment of Hymenoptera venom allergy. Different extracts and treatment schedules are available.


OBJECTIVE
To compare the safety and efficacy of immunotherapy in 3 cohorts of patients sensitized to Vespula species.


METHODS
In this open study, 43 patients were treated with a subcutaneous aqueous extract for induction and maintenance (AA), 34 with a subcutaneous depot extract for induction and maintenance (DD), and 29 with subcutaneous aqueous and subcutaneous depot extracts for induction and maintenance, respectively (AD). Cluster schedules were followed to reach maintenance, and adverse effects during treatment and after naturally occurring stings were recorded.


RESULTS
Depot immunotherapy was better tolerated mainly owing to the lower frequency of local adverse effects in the induction phase (5.9% vs 42.5% and 1.3% vs 5.1% on a per patient and per dose basis, respectively; P < .001 for both) and for effects occurring within 60 minutes after vaccination (2.9% vs 19.2% and 0.2% vs 2.8% on a per patient and per dose basis; P = .03 and P < .001, respectively). Furthermore, 19 of 20 AA, 9 of 9 AD, and 10 of 10 DD patients who were restung experienced only minor local effects.


CONCLUSIONS
Venom immunotherapy is efficacious. Although there was no decrease in systemic reactions, depot immunotherapy to Vespula venom induced fewer early local adverse effects. Patients undergoing an induction phase with an aqueous extract can benefit from switching to a depot extract during maintenance. Increasing the flexibility of the immunization schedules may improve compliance with this potentially lifesaving treatment.
Alessandrini
Arnaldo E
AE
Internal Medicine Unit, C. Cantù Hospital, Abbiategrasso, Italy.
Berra
Daniele
D
Rizzini
Fabio Lodi
FL
Mauro
Marina
M
Melchiorre
Antonietta
A
Rossi
Francesco
F
Spezia
Daniele
D
Stanizzi
Rosario
R
Ricciardi
Luisa
L
Burastero
Samuele E
SE
D000327:Adsorption; D000485:Allergens / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D000818:Animals; D015331:Cohort Studies; D003692:Delayed-Action Preparations; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007115:Immunization Schedule; D007279:Injections, Subcutaneous; D010349:Patient Compliance; D012720:Severity of Illness Index; D012995:Solubility; D016896:Treatment Outcome; D014862:Wasp Venoms / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D014867:Water
D000485:Allergens; D003692:Delayed-Action Preparations; D014862:Wasp Venoms; D014867:Water