title: Long-Term Follow-Up of Children after Venom Immunotherapy: Low Adherence to Anaphylaxis Guidelines.
abstract: BACKGROUND
  Data on the long-term outcome of children after specific venom immunotherapy (VIT) are limited. Therefore, we assessed sting recurrence and anaphylaxis relapse rates as well as adherence to anaphylaxis guidelines with regard to the availability of emergency equipment and education status.
  
  
  METHODS
  For this long-term survey, data of 311 children with a history of anaphylactic reactions to hymenoptera stings were collected by chart review. We included patients who were treated with a 3-year VIT between 1993 and 2009 and had completed a questionnaire.
  
  
  RESULTS
  Forty of the 311 patients were included. Mean VIT duration was 3.1 years. Of the 40 patients included, 29 children (72.5%) received VIT with vespid venom, 9 with bee venom, and 2 patients with both venoms. During a mean follow-up period of 13 years, 20/40 patients (50%) suffered re-stings. Six of the 20 (30%) patients developed again anaphylactic symptoms (grade 1 n = 5, grade 3 n = 1); 2 were allergic to vespid and 4 to bee venom. Of the entire cohort, only 5/40 (12.5%) had appropriate emergency kits according to the guidelines of the European Academy of Allergy and Clinical Immunology. Among the patients who had emergency kits available, one third (5/15) felt uncertain about the correct application of the medication. Less than two thirds of our population (25/40) affirmed that they have been educated in emergency management. The vast majority (95%; 38/40) of our patients did not have allergy follow-ups after VIT completion.
  
  
  CONCLUSIONS
  Anaphylactic relapses are not uncommon, and there are considerable deficits in the emergency management of patients. Hence, comprehensive standardized anaphylaxis education programs as well as regular follow-ups of the allergy status are crucial.
authors.affiliation: Division of Pediatric Pneumology and Allergy, University Hospital for Children and Adolescents, Leipzig, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Fiedler
authors.forename: Ulrich
authors.initials: U
authors.lastname: Miehe
authors.forename: Regina
authors.initials: R
authors.lastname: Treudler
authors.forename: Wieland
authors.initials: W
authors.lastname: Kiess
authors.forename: Freerk
authors.initials: F
authors.lastname: Prenzel
mesh_terms: D000293:Adolescent; D000707:Anaphylaxis / Q000209:etiology / Q000517:prevention & control*; D000818:Animals; D001514:Bee Venoms / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003888:Desensitization, Immunologic; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007299:Insect Bites and Stings / Q000097:blood / Q000150:complications / Q000276:immunology; D008297:Male; D010349:Patient Compliance; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D012008:Recurrence; D011795:Surveys and Questionnaires; D014862:Wasp Venoms / Q000276:immunology*
chemical_list: D001514:Bee Venoms; D014862:Wasp Venoms; D007073:Immunoglobulin E
keywords: Adrenaline auto-injector; Anaphylaxis; Children and adolescents; Education programs; Emergency kits; Hymenoptera venom allergy; Long-term protection; Re-sting reactions; Venom immunotherapy