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01.12.2018 | Research | Ausgabe 1/2018 Open Access

Clinical and Molecular Allergy 1/2018

A 13-year real-life study on efficacy, safety and biological effects of Vespula venom immunotherapy

Clinical and Molecular Allergy > Ausgabe 1/2018
Marcello Albanesi, Andrea Nico, Alessandro Sinisi, Lucia Giliberti, Maria Pia Rossi, Margherita Rossini, Georgios Kourtis, Anna Simona Rucco, Filomena Loconte, Loredana Muolo, Marco Zurlo, Danilo Di Bona, Maria Filomena Caiaffa, Luigi Macchia
Wichtige Hinweise

Electronic supplementary material

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 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).
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