Efficacy of antihistamine pretreatment in the prevention of adverse reactions to Hymenoptera immunotherapy: A prospective, randomized, placebo-controlled trial☆,☆☆,★,★★
Section snippets
Patients
One hundred twenty-one patients (52 men and 69 women), aged 18 to 70 years undergoing Hymenoptera venom hyposensitization, were enrolled in the study. The clinical data of the 121 patients are given in Table I. Inclusion criteria were a documented systemic anaphylaxis to honeybee (Apis mellifera) or yellow jacket (Vespula spp.) stings (grade I, II, III, or IV according to Ring and Messmer15) and demonstration of a sensitization (positive intracutaneous skin test response to bee or yellow jacket
Results
Of the 121 patients who participated in the study, 41 were randomized to terfenadine plus ranitidine treatment, 41 to terfenadine treatment, and 39 to placebo treatment. With respect to demographic data, there were no statistically significant differences between the groups (Table I). The number of patients completing the study was greater in the terfenadine plus ranitidine group (36 patients, 88%) and the terfenadine group (33 patients, 81%) than in the placebo group (28 patients, 72%).
Discussion
The prospective, placebo-controlled study in 121 subjects undergoing specific hyposensitization with insect venom over 50 weeks showed that local and systemic reactions during immunotherapy can be significantly reduced by pretreatment with terfenadine or terfenadine and ranitidine in combination. Regarding local reactions, we found a significant reduction in severity of erythema, edema, and pruritus after venom injections in the initial phase of immunotherapy. Local swelling at the injection
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Peanut Oral Immunotherapy With or Without H<inf>1</inf> and H<inf>2</inf> Antihistamine Premedication for Peanut Allergy (PISCES): A Placebo-Controlled Randomized Clinical Trial
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2022, Immunology and Allergy Clinics of North AmericaCitation Excerpt :Risk factors for reactions include treatment with HB venom, an elevated sBT level, and use of an ultrarush build-up protocol.19 The use of H1 and H2 antagonists for premedication can decrease the risk of local and systemic side effects during VIT.52 Finally, omalizumab has been used as a pretreatment and concurrent treatment strategy for patients with and without MCD who experience recurrent reactions to VIT.53
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2022, Allergic and Immunologic Diseases: A Practical Guide to the Evaluation, Diagnosis and Management of Allergic and Immunologic DiseasesAntihistamine premedication improves safety and efficacy of allergen immunotherapy
2021, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :The European Academy of Allergy and Clinical Immunology (EAACI) Guidelines on AIT for allergic rhinoconjunctivitis recommend premedication with an antihistamine because it reduces the frequency and severity of local and systemic cutaneous reactions, despite not eliminating the risk of other SRs.12 Similarly, the EAACI Guidelines on AIT for Hymenoptera Venom Allergy13 recommend premedication with an antihistamine as it can improve the tolerability of venom immunotherapy and reduce large LRs, and to some extent also systemic AEs.9,10,14,15 The evidence for antihistamine pretreatment in AIT for house dust mite (HDM)–driven allergic asthma and food allergy, however, is still lacking.16,17
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From aDepartment of Dermatology and Allergy Biederstein, Technical University Munich; bDepartment of Dermatology, University Hospital Eppendorf, Hamburg; and cInstitute of Mathematics and Computer Science in Medicine, University Hospital Eppendorf, Hamburg.
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Supported by a grant from Marion Merrell Dow, Germany.
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Reprint requests: Knut Brockow, MD, Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Straße 29, 80802 München, Germany.
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