title: Flexible approaches in the design of subcutaneous immunotherapy protocols for Hymenoptera venom allergy.
abstract: 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.
authors.affiliation: Internal Medicine Unit, C. Cantù Hospital, Abbiategrasso, Italy.
authors.forename: Arnaldo E
authors.initials: AE
authors.lastname: Alessandrini
authors.forename: Daniele
authors.initials: D
authors.lastname: Berra
authors.forename: Fabio Lodi
authors.initials: FL
authors.lastname: Rizzini
authors.forename: Marina
authors.initials: M
authors.lastname: Mauro
authors.forename: Antonietta
authors.initials: A
authors.lastname: Melchiorre
authors.forename: Francesco
authors.initials: F
authors.lastname: Rossi
authors.forename: Daniele
authors.initials: D
authors.lastname: Spezia
authors.forename: Rosario
authors.initials: R
authors.lastname: Stanizzi
authors.forename: Luisa
authors.initials: L
authors.lastname: Ricciardi
authors.forename: Samuele E
authors.initials: SE
authors.lastname: Burastero
mesh_terms: 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
chemical_list: D000485:Allergens; D003692:Delayed-Action Preparations; D014862:Wasp Venoms; D014867:Water