Background and Objective: Different clinical behaviors have been identified in patients allergic to bee venom. Compound-resolved diagnosis could be an appropriate tool for investigating these differences. The aims of this study were to analyze whether specific IgE to Api m 4 (sIgE-Api m 4) can identify a particular kind of bee venom allergy and to describe response to bee venom immunotherapy (bVIT). Methods: Prospective study of 31 patients allergic to bee venom who were assigned to phenotype group A (sIgE-Api m 4 <0.98 kU/L), treated with native aqueous (NA) extract, or phenotype group B (sIgE-Api m 4 ≥0.98 kU/L), treated with purified aqueous (PA) extract. Sex, age, cardiovascular risk, severity of preceding sting reaction, exposure to beekeeping, and immunological data (intradermal test, sIgE/ sIgG4-Apis-nApi m 1, and sIgE-rApi m 2-Api m 4 were analyzed. Systemic reactions (SRs) during bVIT build-up were analyzed. Immunological and sting challenge outcomes were evaluated in each group after 1 and 2 years of bVIT. Results: Phenotype B patients had more severe reactions (P=.049) and higher skin sensitivity (P=.011), baseline sIgE-Apis (P=.0004), sIgE-nApi m 1 (P=.0004), and sIgG4-Apis (P=.027) than phenotype A patients. Furthermore, 41% of patients in group B experienced SRs during the build-up phase with NA; the sting challenge success rate in this group was 82%. There were no significant reductions in serial intradermal test results, but an intense reduction in sIgE-nApi m 1 (P=.013) and sIgE-Api m 4 (P=.004) was observed after the first year of bVIT. Conclusion: Use of IgE-Api m 4 as the only discrimination criterion demonstrated differences in bee venom allergy. Further investigation with larger populations is necessary.
Background: There is controversy whether taking β-blockers or ACE
inhibitors (ACEI) is a risk factor for more severe systemic insect sting
reactions (SSR) and whether it increases the number or severity of
adverse events (AE) during venom immunotherapy (VIT). Methods: In this
open, prospective, observational, multicenter trial, we recruited
patients with a history of a SSR and indication for VIT. The primary
objective of this study was to evaluate whether patients taking
β-blockers or ACEI show more systemic AE during VIT compared to patients
without such treatment. Results: In total, 1,425 patients were enrolled
and VIT was performed in 1,342 patients. Of all patients included, 388
(27.2%) took antihypertensive (AHT) drugs (10.4% took β-blockers,
11.9% ACEI, 5.0% β-blockers and ACEI). Only 5.6% of patients under
AHT treatment experienced systemic AE during VIT as compared with 7.4%
of patients without these drugs (OR: 0.74, 95% CI: 0.43–1.22, p=0.25).
The severity of the initial sting reaction was not affected by the
intake of β-blockers or ACEI (OR: 1.14, 95% CI: 0.89–1.46, p=0.29). In
total, 210 (17.7%) patients were re-stung during VIT and 191 (91.0%)
tolerated the sting without systemic symptoms. Of the 19 patients with
VIT treatment failure, 4 took β-blockers, none an ACEI. Conclusions:
This trial provides robust evidence that taking β-blockers or ACEI does
neither increase the frequency of systemic AE during VIT nor aggravate
SSR. Moreover, results suggest that these drugs do not impair
effectiveness of VIT. (Funded by Medical University of Graz, Austria;
Clinicaltrials.gov number, NCT04269629)
Comparative studies of media contrast safety are scarce and summary information on product characteristics is insufficient. This study showed the differences in severity and profile of adverse reactions between iopromide and iomeprol.
The safety profile of the cluster regimen supports the use of accelerated SCIT schedules with IR-standardized allergen extracts compared with short conventional schedules, particularly if similar extracts and application methods are used.
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