A comparison of venom treatment and no treatment in insect allergic children

The sting challenge test in Hymenoptera venom allergy Position paper of the subcommittee on Insect Venom Allergy of the European Academy of Allergology and Clinical Immunology

“…It has been shown that after Hymenoptera stings there is an increase in the skin test reactivity and specific serum IgE to the relevant venom (51)(52)(53)(54). It has been shown that after Hymenoptera stings there is an increase in the skin test reactivity and specific serum IgE to the relevant venom (51)(52)(53)(54).…”

Venom immunotherapy reduces large local reactions to insect stings

“…An abstract by Walker et al 12 showed that rush immunotherapy prevented LLRs to fire ant stings. Schuberth et al 13 reported that significantly fewer LLRs occurred in venom-treated (compared with untreated) children who had a history of previous mild systemic reactions to stings. Most recently, the initial response to 6 months of sublingual immunotherapy with honeybee venom was reported to be associated with reduced LLRs to stings and increased venom-specific IgG antibody levels.…”

Immunotherapy with Hymenoptera venoms

“…According to prospective studies (Table 1) 20-84% of patients who have experienced systemic anaphylactic symptoms and demonstrate venom specific IgE do not have another systemic reaction when restung by the same insect species. It appears that the rate Table 1 Prospective studies on the natural history of Hymenoptera sting allergy of spontaneous hyposensitization is higher in mild than in severe systemic reactions (6,29,37,47,58,63,69,70,75,76) in children than in adults (see Table 1), and in vespid than in honey bee sting allergy (6), Some authors claim that the IgG/IgE ratio may help to define high risk patients (81,85), The diagnosis of allergy to venoms is based on a suggestive history of anaphylaxis, positive skin tests to venoms, or the presence of serum venom specific IgE, Wiithrich et al (49,89) proposed adding basophil degranulation tests to this panel, since this was shown to enhance the diagnosis in difficult cases. The diagnostic criteria differ according to investigators.…”

“…Children with mild systemic reactions (see Table 2) (47,75,76) do not appear to be candidates for VIT, even in the presence of positive diagnostic tests, unless they are at a high risk of re-exposure and have presented several systemic reactions of increasing severity following Hymenoptera stings. However, if VIT is withheld, patients should be informed that severe anaphylactic reactions at a re-exposure, although unlikely, are still possible, and an emergency treatment set including adrenaline must be prescribed and self-administered if these patients are accidentally stung and develop symptoms.…”

“…In one study, after 3 years of treatment (79) only 15 out of 42 adult patients were negative. Disappearance of positive diagnostic tests seems to occur more frequently in children (30,76). It must, however, be realized that RAST interference due to the presence of high titers of venom specific IgG might cause false negative IgE-RAST results in patients under VIT (92).…”