Practice of venom immunotherapy in the United Kingdom: a national audit and review of literature.
BACKGROUND
Venom immunotherapy (VIT) is the only effective treatment for prevention of serious allergic reactions to bee and wasp stings in sensitized individuals. However, controversies exist relating to diagnosis, indications for treatment and treatment schedules. We audited current practice of VIT in the United Kingdom to evaluate adherence to international guidelines.


METHODS
An online questionnaire was sent to all clinicians practising immunotherapy identified on the British Society of Allergy and Clinical Immunology website. Eighty-six questionnaires were sent and 53 responses (61.6%) were received. Of these, 48 (85%) carried out VIT at their centre.


RESULTS
Skin prick tests (SPT) and serum venom-specific IgE (SSIgE) were equally preferred as first-line investigation. Fifty percent of the respondents perform intradermal tests if both SPT and SSIgE are negative. While 8% of respondents commence VIT in patients with negative SSIgE and a history of severe reaction, 57% prefer to repeat the tests in 6-12 months if serum tryptase is elevated. If the insect responsible is uncertain and SSIgE is detected against bee and wasp venoms, 22% of the respondents will desensitize to both while 32% initiate treatment against the venom with the higher SSIgE. A protocol of weekly up-dosing for 12 weeks is preferred for induction and only 25% of respondents have ever used rush or ultra-rush protocols. Three years is thought to be optimum duration of VIT by most (56%). Eleven percent perform sting challenges at the end of treatment. Although 47% measure SSIgE at the end of treatment, only 3% use these results as a basis for discontinuing VIT.


CONCLUSIONS
Currently there is considerable variation in the diagnosis and management of hymenoptera venom allergy in the United Kingdom. This audit has demonstrated that the current international guidelines for the diagnosis and management of hymenoptera venom allergy are not being followed by UK allergy practitioners.
Diwakar
L
L
Department of Allergy and Immunology, Heartlands Hospital, Birmingham, UK. Lavanya.diwakar@heartofengland.nhs.uk
Noorani
S
S
Huissoon
A P
AP
Frew
A J
AJ
Krishna
M T
MT
D000818:Animals; D001514:Bee Venoms / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D007073:Immunoglobulin E / Q000097:blood; D007167:Immunotherapy / Q000009:adverse effects / Q000379:methods*; D008485:Medical Audit; D012882:Skin Tests; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D014862:Wasp Venoms / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*
D001514:Bee Venoms; D014862:Wasp Venoms; D007073:Immunoglobulin E