The online version of this article (https://doi.org/10.1186/s12948-017-0079-y) contains supplementary material, which is available to authorized users.
Hymenoptera venom immunotherapy (VIT) is a clinically effective treatment. However, little is known about its long-term clinical efficacy and biological effects. Several mechanisms have been proposed to account for VIT efficacy, including reduction of specific IgE and induction of allergen-specific IgG4, but the overall picture remains elusive. We investigated Vespula VIT clinical efficacy up to 8 years after discontinuation and the kinetics of Vespula-specific IgE and IgG4. Out of 686 consecutive patients we retrospectively selected and analysed a series of 23 patients with Vespula allergy that underwent a 5-year IT course, followed by a prolonged follow-up.
Clinical efficacy of VIT was assessed as number and severity of reactions to Vespula re-stinging events. The presence of Vespula-specific IgE and IgG4 was also monitored over time.
During the VIT treatment, patients were protected, reporting no reactions or mild reactions in occasion of re-stinging events. This protection was entirely maintained during the follow-up, up to 8 years. Skin reactivity (reflecting mast cell-bound Vespula-specific IgE) and circulating Vespula-specific IgE levels declined substantially during VIT. Notably, this reduction was maintained over time during the follow-up. Moreover, all the patients were analysed for IgG4. A robust induction of Vespula-specific IgG4 was observed during the VIT course, with a substantial decline during the follow-up.
We conclude that Vespula VIT is a clinically effective treatment, which induces long-term protection after discontinuation. The reduction of specific IgE, assessed by skin tests and RAST, closely matches the VIT- induced protection, while the IgG4 induction seems not to be associated with VIT clinical efficacy in the long term.
Additional file 1: Table S1. Comparative table of the existing reports on long-term clinical efficacy of VIT.
Additional file 2: Table S2. ALK-Abellò VIT protocol.
Additional file 3: Table S3. DHS VIT protocol.
Additional file 4: Figure S1. Kinetics of Vespula-specific IgE (A) and IgG4 (B) in response to DHS or ALK-Abellò VIT (C) Ratio between Vespula-specific IgE and IgG4 during VIT course and follow-up. Data in A and B were analised by ANOVA with Bonferroni post-test (n.s.>0.01).
Müller UR. Insect sting allergy: clinical picture, diagnosis, and treatment. Stuttgart: Gustav-Fischer Verlag; 1990.
Patriarca G et al. Sublingual desensitization in patients with wasp venom allergy: preliminary results. Int J Immunopathol Pharmacol. 2008;21:669–77.
Diane F, Jelinek I, James T. Immunoglobulin structure and functions. In: Franklin Adkinson N, Bochner B, Wesley Burks A, Holgate ST, Lemanske RF, editors. Middleton’s, allergy. Elsevier Saunders; 2014. 1: p. Chapter 3:30–45.
Carr TF, Saltoun CA. Chapter 2: Skin testing in allergy. In: Allergy Asthma Proceedings. 2012. 33;1:S6–8.
Golden DB. Insect sting anaphylaxis. Immunol Allergy Clin N Am. 2007;27(2):261–72. CrossRef
Wuthrich B, Arrendal H, Lanner A. Antibody response pattern (specific IgE and IgG) of insect sting allergic patients in immunotherapy with venom preparations. Schweiz Med Wochenschr. 1981;111(46):1756–65. PubMed
- A 13-year real-life study on efficacy, safety and biological effects of Vespula venom immunotherapy
Maria Pia Rossi
Anna Simona Rucco
Danilo Di Bona
Maria Filomena Caiaffa
- BioMed Central
Neu im Fachgebiet HNO
e.Med Kampagnen-Visual, Mail Icon II