title: Venom immunotherapy: clinical efficacy, safety and contraindications.
abstract: Venom-specific immunotherapy (VIT) is considered for the treatment of patients with IgE-mediated systemic allergic reactions (SARs) after developing a Hymenoptera venom allergy. Tolerance is achieved in a majority of patients after only a few days or even hours of rush immunotherapy. After VIT discontinuation, the allergy returns in up to 15% of patients. During VIT, the majority of patients have local reactions at the site of venom injections. SARs to VIT are much more frequent in honeybee-treated patients than in wasp-treated patients. Increased baseline serum tryptase and increased allergen-specific sensitivity of basophils are other factors that might be associated with systemic reactions (SRs) during VIT. Severe SRs occur mainly during the build-up phase but can also occur in the maintenance phase of the VIT, even in patients with a well-tolerated dose-increase phase. Pre-treatment with humanized anti-IgE antibodies (omalizumab) is effective in patients with repeated SARs; however, this use of omalizumab is off-label. In highly exposed patients with a history of very severe reactions, there are virtually no absolute contraindications for VIT.
authors.affiliation: University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia and Medical Faculty, Ljubljana, Slovenia.
authors.forename: Mitja
authors.initials: M
authors.lastname: Kosnik
authors.forename: Peter
authors.initials: P
authors.lastname: Korosec
mesh_terms: D000485:Allergens / Q000008:administration & dosage / Q000276:immunology*; D000818:Animals; D015549:Basophil Degranulation Test; D000075202:Contraindications; D006801:Humans; D006927:Hymenoptera; D006967:Hypersensitivity / Q000276:immunology / Q000628:therapy*; D007108:Immune Tolerance; D007167:Immunotherapy; D000069444:Omalizumab / Q000627:therapeutic use; D053802:Tryptases / Q000097:blood; D014688:Venoms / Q000008:administration & dosage / Q000276:immunology*
chemical_list: D000485:Allergens; D014688:Venoms; D000069444:Omalizumab; D053802:Tryptases
keywords: Hymenoptera venom allergy; anaphylaxis; basophil allergen sensitivity; contraindications; immunotherapy; side effects; tryptase