Background
Methods
Patients
Collection of data
Allergy testing
Venom immunotherapy
Protocol | 3 days | 5 days | ||
---|---|---|---|---|
Day | Dose (µg) | Day | Dose (µg) | |
1 | .1 | 1 | .02 | |
1 | .08 | |||
10 | .2 | |||
.4 | ||||
2 | 20 | 2 | .8 | |
30 | 2 | |||
40 | 4 | |||
6 | ||||
3 | 50 | 3 | 8 | |
50 | 20 | |||
40 | ||||
4 or 5a
| 100b
| 4 | 50 | |
80 | ||||
5 | 100b
| |||
Cumulative dose (µg) | 301.1 | 311.5 | ||
Number of injections (n) | 9 | 14 |
Classification of VIT-related adverse reactions and grading of anaphylaxis
Statistical analysis
Results
Patient cohort
Total | Children | Adults |
P valuea
| ||||
---|---|---|---|---|---|---|---|
n | % | n | % | n | % | ||
Age (years) at VIT-initiation, median (IQR) | 47 (20) | 14 (6) | 48 (19) | ||||
Sex | |||||||
Male | 580 | 55.1 | 45 | 63.4 | 535 | 54.5 | .17 |
Female | 472 | 44.9 | 26 | 36.6 | 446 | 45.5 | |
Diagnosis: IgE-mediated allergy to | |||||||
Bee venom | 167 | 15.9 | 23 | 32.4 | 144 | 14.7 | <.001 |
Vespula venom | 856 | 81.4 | 47 | 66.2 | 809 | 82.5 | |
Bee and Vespula venom | 29 | 2.8 | 1 | 1.4 | 28 | 2.9 | |
IgE to causative insect (kU/L), median (IQR) | |||||||
Bee venom | 8.7 (22.2) | 15.3 (36.6) | 8.0 (21.0) | .013 | |||
Vespula venom | 4.8 (11.4) | 6.7 (15.5) | 4.8 (11.2) | .37 | |||
Baseline serum tryptase concentration | |||||||
Availabilityb
| 628 | 59.7 | 33 | 46.5 | 595 | 60.7 | |
Median (µg/L) (IQR) | 4.4 (3.2) | 3.5 (1.9) | 4.4 (3.2) | .014 | |||
Severity of index sting-induced anaphylaxis | |||||||
Grade I (mild) | 138 | 13.1 | 5 | 7.0 | 133 | 13.6 | |
Grade II (moderate) | 647 | 61.5 | 59 | 83.1 | 588 | 59.9 | |
Grade III (severe) | 267 | 25.4 | 7 | 9.9 | 260 | 26.5 | .001 |
Cardiovascular comorbidities | 289 | 27.5 | 0 | 0 | 289 | 29.5 | <.001 |
Concurrent cardiovascular medication | |||||||
Any | 277 | 26.3 | 0 | 0 | 277 | 28.2 | <.001 |
ACE-inhibitor | 131 | 12.5 | 0 | 0 | 131 | 13.4 | <.001 |
Beta-blocker | 59 | 5.6 | 0 | 0 | 59 | 6 | .028 |
Latency (months) from index sting to VIT, median (IQR) | 7 (7) | 8 (6) | 7 (7.5) | .19 |
Course of VIT
Predictors of VIT-induced anaphylaxis
Severity grading of VIT-induced anaphylaxis in pediatric patients
Patient no. | 1 | 2 | 3 | 4 | 5 |
---|---|---|---|---|---|
History | |||||
Age (years) | 7 | 7 | 7 | 15 | 17 |
Sex | F | M | M | F | M |
Causative venom | Bee |
Vespula
|
Vespula
|
Vespula
| Bee |
Severity of anaphylaxis at index sting (grade) | II | II | II | III | II |
Relevant comorbidities | None | None | Asthma | None | None |
Concurrent medication | None | None | Yesa
| None | None |
VIT-induced anaphylaxis | |||||
Severity (grade) | II | I | I | I | I |
Symptoms | |||||
Urticaria/angioedema | + | + | + | + | + |
Respiratory | + | − | − | − | − |
Gastrointestinal | + | − | − | − | − |
Cardiovascular | − | − | − | − | − |
Injection protocol | 3 days | 3 days | 3 days | 3 days | 5 days |
Venom dose prior to reaction (µg) | 50 | 40 | 50 | 40 | 8 |
Time interval to injection (minutes) | 15 | 60 | 120 | 25 | 60 |
Treatment | |||||
Antihistamine | i.v. | Oral | i.v. | i.v. | Oral |
Steroid | i.v. | − | − | − | − |
Epinephrine | − | − | − | − | − |
Inhalative beta2-adrenergic agonist | + | − | − | − | − |