title: Predictors of side effects during the buildup phase of venom immunotherapy for Hymenoptera venom allergy: the importance of baseline serum tryptase.
abstract: BACKGROUND
  Severe side effects during venom immunotherapy (VIT) are associated with a variety of risk factors.
  
  
  OBJECTIVE
  Our aim was to evaluate the association of baseline serum tryptase concentration (BTC) and of other parameters, which are routinely recorded during patient evaluation, with the frequency of severe reactions requiring an emergency intervention during the buildup phase of VIT.
  
  
  METHODS
  In this observational prospective multicenter study, we enrolled 680 patients with established honeybee or vespid venom allergy who underwent VIT. Data were collected on tryptase concentration, age, sex, culprit insect, cardiovascular medication, degree of preceding sting reaction, preventive antiallergic medication before therapy, time between last preceding sting reaction and VIT, venom specific IgE concentration, and type of buildup procedure. Relative rates were calculated with generalized additive models.
  
  
  RESULTS
  Fifty-seven patients (8.4%) required an emergency intervention during buildup because of a severe systemic reaction. The frequency of interventions increased significantly with higher BTC (log-linear association; adjusted odds ratio, 1.56; 95% CI, 1.15-2.11; P < .005). The predictive power of BTC was markedly greater when VIT was performed for vespid venom allergy than for bee venom (for bee VIT, no significant association; for vespid VIT, log-linear association; adjusted odds ratio, 2.33; 95% CI, 1.28-4.26; P = .005). The most important other factor significantly associated with severe reactions during the buildup phase of VIT was bee venom allergy.
  
  
  CONCLUSIONS
  Before vespid VIT, measurement of baseline serum tryptase concentration should be used to identify patients with a high risk for side effects. Patients with bee venom allergy require a particularly high degree of surveillance during VIT.
authors.affiliation: Department of Dermatology and Allergology, Ludwig-Maximilians-Universität, Munich, Germany. Franziska.Rueff@med.uni-muenchen.de
authors.forename: Franziska
authors.initials: F
authors.lastname: Ruëff
authors.forename: Bernhard
authors.initials: B
authors.lastname: Przybilla
authors.forename: Maria Beatrice
authors.initials: MB
authors.lastname: Biló
authors.forename: Ulrich
authors.initials: U
authors.lastname: Müller
authors.forename: Fabian
authors.initials: F
authors.lastname: Scheipl
authors.forename: Werner
authors.initials: W
authors.lastname: Aberer
authors.forename: Joëlle
authors.initials: J
authors.lastname: Birnbaum
authors.forename: Anna
authors.initials: A
authors.lastname: Bodzenta-Lukaszyk
authors.forename: Floriano
authors.initials: F
authors.lastname: Bonifazi
authors.forename: Christoph
authors.initials: C
authors.lastname: Bucher
authors.forename: Paolo
authors.initials: P
authors.lastname: Campi
authors.forename: Ulf
authors.initials: U
authors.lastname: Darsow
authors.forename: Cornelia
authors.initials: C
authors.lastname: Egger
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Haeberli
authors.forename: Thomas
authors.initials: T
authors.lastname: Hawranek
authors.forename: Iwona
authors.initials: I
authors.lastname: Kucharewicz
authors.forename: Helmut
authors.initials: H
authors.lastname: Küchenhoff
authors.forename: Roland
authors.initials: R
authors.lastname: Lang
authors.forename: Oliviero
authors.initials: O
authors.lastname: Quercia
authors.forename: Norbert
authors.initials: N
authors.lastname: Reider
authors.forename: Maurizio
authors.initials: M
authors.lastname: Severino
authors.forename: Michael
authors.initials: M
authors.lastname: Sticherling
authors.forename: Gunter Johannes
authors.initials: GJ
authors.lastname: Sturm
authors.forename: Brunello
authors.initials: B
authors.lastname: Wüthrich
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001180:Arthropod Venoms / Q000276:immunology*; D003888:Desensitization, Immunologic / Q000009:adverse effects*; D004630:Emergencies; D005260:Female; D006801:Humans; D006927:Hymenoptera / Q000276:immunology*; D006967:Hypersensitivity / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D053802:Tryptases / Q000097:blood*
chemical_list: D001180:Arthropod Venoms; D053802:Tryptases