Introduction: Venom immunotherapy (VIT) is highly effective and the treatment of choice for patients with a history of systemic anaphylactic reactions to a Hymenoptera sting. It has been assumed that VIT protocols with a rapid dose increase during the induction phase are associated with a higher frequency of systemic reactions (SR); however, study data addressing this issue are conflicting. Objective: The aim of this study was to compare the safety of 3 different Hymenoptera VIT protocols (half-day ultra-rush, 3-day rush, 3-week cluster). Methods: This retrospective 2-center study included 143 Hymenoptera venom-allergic patients, who underwent 147 VIT procedures during the years 2015–2018. Twenty cluster, 75 rush, and 52 ultra-rush VIT protocols were performed with honeybee (54 protocols) and wasp (93 protocols) venom. All documented side effects were classified into large local and SR (Ring and Messmer classification). Results: SR were observed during 11 (7.5%) VIT procedures and did not exceed severity grade II. SR occurred more frequently in cluster compared to accelerated protocols. This result was observed for both honeybee (cluster: 25%, rush: 8.7%, and ultra-rush: 15.8%) and wasp VIT (cluster: 12.5%, rush: 0%, and ultra-rush: 6.1%), though the differences were statistically significant only in the wasp VIT subgroup. Honeybee venom elicited more SR than wasp venom (14.8 and 3.2%, respectively, p = 0.01). The risk for SR did not depend on age, sex, concomitant antihypertensive medication, hypertryptasemia, or severity of the index sting reaction. Conclusion: Accelerated VIT protocols, namely, rush and ultra-rush protocols are safe therapeutic options for Hymenoptera venom-allergic patients and displayed fewer SR than cluster VIT protocols in our study.
Int Arch Allergy Immunol

中文翻译：

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3种不同的膜翅目毒液免疫治疗方案的安全性比较：143例患者的回顾性两中心研究。

简介：毒液免疫疗法（VIT）是高度有效的疗法，是对膜翅目有全身过敏性反应史的患者的首选治疗方法。假定在诱导期剂量迅速增加的VIT方案与更高的全身性反应（SR）频率相关。但是，解决该问题的研究数据却相互矛盾。目的：本研究的目的是比较3种不同的膜翅目膜翅目VIT方案的安全性（半天超冲，三天冲，三周群集）。方法：这项回顾性的2中心研究包括143例膜翅目毒液过敏患者，他们在2015-2018年期间接受了147例VIT手术。使用蜜蜂（54个规程）和黄蜂（93个规程）毒液进行了二十个簇，75个急诊和52个超急诊VIT规程。所有已记录的副作用均分为局部大和SR（Ring和Messmer分类）。结果：在11项（7.5％）VIT程序中观察到SR，且未超过严重程度II级。与加速协议相比，SR在群集中的发生频率更高。不过，对于蜜蜂（集群：25％，奔跑：8.7％和超奔跑：15.8％）和黄蜂VIT（集群：12.5％，奔跑：0％和超奔跑：6.1％）都观察到了这一结果仅在wasp VIT亚组中，差异具有统计学意义。蜜蜂毒液引起的SR比黄蜂毒液高（分别为14.8和3.2％，p = 0.01）。发生SR的风险不取决于年龄，性别，同时使用降压药，胰高血糖症或指数刺痛反应的严重性。结论：加速的VIT方案，即急速和超急速方案是膜翅目毒液过敏患者的安全治疗选择，并且在我们的研究中显示的SR比簇状VIT方案少。
Int Arch过敏免疫