title: Clinical effectiveness of hymenoptera venom immunotherapy: a prospective observational multicenter study of the European academy of allergology and clinical immunology interest group on insect venom hypersensitivity.
abstract: BACKGROUND
  Treatment failure during venom immunotherapy (VIT) may be 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 with the frequency of VIT failure during the maintenance phase.
  
  
  METHODS
  In this observational prospective multicenter study, we followed 357 patients with established honey bee or vespid venom allergy after the maintenance dose of VIT had been reached. In all patients, VIT effectiveness was either verified by sting challenge (n = 154) or patient self-reporting of the outcome of a field sting (n = 203). Data were collected on BTC, age, gender, preventive use of anti-allergic drugs (oral antihistamines and/or corticosteroids) right after a field sting, venom dose, antihypertensive medication, type of venom, side effects during VIT, severity of index sting reaction preceding VIT, and duration of VIT. Relative rates were calculated with generalized additive models.
  
  
  RESULTS
  22 patients (6.2%) developed generalized symptoms during sting challenge or after a field sting. A strong association between the frequency of VIT failure and BTC could be excluded. Due to wide confidence bands, however, weaker effects (odds ratios <3) of BTC were still possible, and were also suggested by a selective analysis of patients who had a sting challenge. The most important factor associated with VIT failure was a honey bee venom allergy. Preventive use of anti-allergic drugs may be associated with a higher protection rate.
  
  
  CONCLUSIONS
  It is unlikely that an elevated BTC has a strong negative effect on the rate of treatment failures. The magnitude of the latter, however, may depend on the method of effectiveness assessment. Failure rate is higher in patients suffering from bee venom allergy.
authors.affiliation: Department of Dermatology and Allergology, Ludwig-Maximilians-Universität, München, 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: Michael J
authors.initials: MJ
authors.lastname: Seitz
authors.forename: Werner
authors.initials: W
authors.lastname: Aberer
authors.forename: Anna
authors.initials: A
authors.lastname: Bodzenta-Lukaszyk
authors.forename: Floriano
authors.initials: F
authors.lastname: Bonifazi
authors.forename: Paolo
authors.initials: P
authors.lastname: Campi
authors.forename: Ulf
authors.initials: U
authors.lastname: Darsow
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Haeberli
authors.forename: Thomas
authors.initials: T
authors.lastname: Hawranek
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: Peter
authors.initials: P
authors.lastname: Schmid-Grendelmeier
authors.forename: Maurizio
authors.initials: M
authors.lastname: Severino
authors.forename: Gunter Johannes
authors.initials: GJ
authors.lastname: Sturm
authors.forename: Regina
authors.initials: R
authors.lastname: Treudler
authors.forename: Brunello
authors.initials: B
authors.lastname: Wüthrich
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000276:immunology / Q000517:prevention & control*; D000818:Animals; D001514:Bee Venoms / Q000276:immunology*; D001516:Bees; D003888:Desensitization, Immunologic; D005260:Female; D006801:Humans; D007299:Insect Bites and Stings / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D017211:Treatment Failure; D014862:Wasp Venoms / Q000276:immunology*; D014863:Wasps
chemical_list: D001514:Bee Venoms; D014862:Wasp Venoms