title: Analysis of safety, risk factors and pretreatment methods during rush hymenoptera venom immunotherapy.
abstract: BACKGROUND
  The safety profile of venom immunotherapy is a relevant issue. We evaluated the frequency of severe adverse events (SAE), associated risk factors, retrospective comparison of pretreatment protocols including solely H1 receptor blockers and a combination of H1 and H2 receptor blockers during rush Hymenoptera venom immunotherapy.
  
  
  METHODS
  The study group comprised 118 patients. The treatment was initiated according to a 5-day rush protocol with the use of standardized venom allergens of either wasp or honeybee.
  
  
  RESULTS
  During the rush induction, side effects occurred in 18 patients (15.2%), whereas SAE were present in 7 patients (5.9%). Twelve out of 18 (66.6%) developed anaphylactic reactions on the fourth day of the rush protocol, with the majority of cases at a dose of 40 or 60 microg of the venom extract (p = 0.001). The frequency of SAE was also significantly higher on the fourth day than thereafter (p = 0.0001) as well as in patients allergic to bee venom (p = 0.049). All systemic side effects were more frequent in women (p = 0.0065). However, this relation was not true when SAE were consider (p = 0.11). A higher percentage of SAE was observed in the subjects pretreated with both H1 and H2 receptor antagonists than in those pretreated with H1 blocker only (8.8 vs. 4.1%); however, the difference was not significant.
  
  
  CONCLUSIONS
  Considerable severity of allergic adverse events requires particular attention to patients allergic to bee venom and during rush phase, especially when rapidly increasing doses are administered. Pretreatment with H2 blockers is debatable and warrants further investigation.
authors.affiliation: Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: Lucyna
authors.initials: L
authors.lastname: Gorska
authors.forename: Marta
authors.initials: M
authors.lastname: Chelminska
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kuziemski
authors.forename: Marcin
authors.initials: M
authors.lastname: Skrzypski
authors.forename: Marek
authors.initials: M
authors.lastname: Niedoszytko
authors.forename: Iwona
authors.initials: I
authors.lastname: Damps-Konstanska
authors.forename: Amelia
authors.initials: A
authors.lastname: Szymanowska
authors.forename: Alicja
authors.initials: A
authors.lastname: Siemińska
authors.forename: Beata
authors.initials: B
authors.lastname: Wajda
authors.forename: Adrianna
authors.initials: A
authors.lastname: Drozdowska
authors.forename: Marek
authors.initials: M
authors.lastname: Jutel
authors.forename: Ewa
authors.initials: E
authors.lastname: Jassem
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D000818:Animals; D001514:Bee Venoms / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D003888:Desensitization, Immunologic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006634:Histamine H1 Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D006927:Hymenoptera / Q000276:immunology*; D007299:Insect Bites and Stings / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome; D014862:Wasp Venoms / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology
chemical_list: D001514:Bee Venoms; D006634:Histamine H1 Antagonists; D014862:Wasp Venoms