title: Hymenoptera venom immunotherapy while maintaining cardiovascular medication: safe and effective.
abstract: BACKGROUND
  The hypothetical risks of cardiovascular medication during Hymenoptera venom immunotherapy (VIT) are still a matter of controversy.
  
  
  OBJECTIVE
  To assess the potential influence of β-blockers (BBs) and/or angiotensin-converting enzyme inhibitors (ACEIs) on the long-term safety and outcome of VIT.
  
  
  METHODS
  Data on the course of VIT maintenance phase, Hymenoptera re-stings, and concurrent medication were retrospectively derived from standardized questionnaires in a cohort of patients with significant cardiovascular comorbidity.
  
  
  RESULTS
  Of 225 patients, 125 (55.6%) were taking cardiovascular medication at the time of data collection: 71 (31.6%) took an ACEI, and 40 (17.8%) took a BB. A total of 3,397 months of maintenance VIT during intake of an ACEI and 1,418 months during BB therapy were evaluated. Cumulative VIT-related reaction rates, including subjective symptoms, were 9.1% per treatment cycle and 0.31% per injection, with objective reaction rates of 1.7% and 0.06%, respectively. The incidence of adverse events was significantly higher in patients with a previous history of systemic reactions at VIT buildup (P = .004). Surprisingly, reaction rates were lower in patients taking any kind of cardiovascular medication (P = .04) or an ACEI (P = .03). The overall reexposure rate to Hymenoptera stings was 42.7%, and the field sting-induced objective reaction rate was 7.3%. There was no evidence of an increase of field sting-related relapse or hospitalization rates by concurrent cardiovascular medication.
  
  
  CONCLUSIONS
  Cardiovascular medication does not impair the safety and/or the efficacy of Hymenoptera VIT.
authors.affiliation: Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany. Electronic address: Stoevesandt_J@ukw.de.
authors.forename: Johanna
authors.initials: J
authors.lastname: Stoevesandt
authors.affiliation: Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Hosp
authors.affiliation: Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kerstan
authors.affiliation: Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Trautmann
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000818:Animals; D001180:Arthropod Venoms / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy*; D003888:Desensitization, Immunologic / Q000009:adverse effects*; D004347:Drug Interactions; D005260:Female; D006801:Humans; D006927:Hymenoptera / Q000737:chemistry*; D006967:Hypersensitivity / Q000150:complications / Q000517:prevention & control*; D007299:Insect Bites and Stings / Q000150:complications / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001180:Arthropod Venoms