Clinical and immunologic effects of H1 antihistamine preventive medication during honeybee venom immunotherapy

Müller, Ulrich; Jutel, Marek; Reimers, Andrea; Zumkehr, Judith; Huber, Claus; Kriegel, Carola; Steiner, Urs; Haeberli, Gabrielle; Akdiş, Mübeccel; Helbling, Arthur; Schnyder, Benno; Blaser, Kurt; Akdiş, Cezmi A.

doi:10.1016/j.jaci.2008.08.007

Cited by 86 publications

(60 citation statements)

References 32 publications

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“…In contrast, other studies [58,59] observed no significant decrease of systemic reactions with the premedication use of antihistamines. It worth mentioning that antihistamine pretreatment does reduce systemic reactions without influencing the efficacy of immunotherapy [57].In conclusion, the present study suggests that SCIT was a safe treatment with a low risk to elicit severe systemic reaction, in which no fatality was observed. Furthermore, this study indicated that mold, HDM, asthma, presence of asthma and allergic rhinitis, polysensitisation, and indoor allergens sensitization were a risk factors contributing to systemic reactions.…”

supporting

confidence: 49%

“…There are controversial findings regarding the influence of antihistamine pretreatment on the occurrence of systemic allergic symptoms during allergen immunotherapy. Some studies indicated that pretreatment with antihistamine lead to a reduction in occurrence of systemic reactions following immunotherapy [52][53][54][55][56][57]. In contrast, other studies [58,59] observed no significant decrease of systemic reactions with the premedication use of antihistamines.…”

mentioning

confidence: 99%

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Systemic Adverse Reaction to Specific Immunotherapy

Alsamarai¹,

Alobaidi²,

Alwan³

et al. 2011

J Aller Ther

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Background: Allergen immunotherapy has been reported to be effective in reducing allergic symptoms and drug consumption in cases of respiratory allergy. However, some concerns still exist about the relative safety of allergen immunotherapy. This form of therapy has a potential risk of serious systemic reactions.Objective: To evaluate the frequency of systemic reactions due to subcutaneous allergen immunotherapy in Iraq and to identify factors associated with increased risk of adverse systemic reaction. Methods:From January 2000 to December 2008, we selected 693 patients with allergic rhinitis and asthma to receive subcutaneous specific immunotherapy. Prospective immunotherapy safety was evaluated by recording postinjection adverse effects. The adverse reaction observed during the administration of subcutaneous immunotherapy within a period of 9 years (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008), was analyzed in this study.Result: Data were obtained from 693 patients who received subcutaneous immunotherapy (SCIT). The mean number of skin tests positivity and number of injections were significantly higher in systemic reaction group compared to negative systemic reaction group. During the study period, a total of 39281 injections were administered to 693 patients. Of the 693 patients, 82 (11.8%) had systemic reaction, with an incidence of 2.1/1000 injection. Sixty nine of the 82 systemic reaction (84%) developed in the build up phase, versus 13 (16%) in the maintenance phase (p<0.0001), with respect to reaction time, 47 (57%) of the systemic reaction were immediate (within 30 minutes respect to reaction time), and 35 (43%) were delayed. There were higher significant influences of polysensitisation, age, asthma, combination of asthma and allergic rhinitis, type of allergen, and indoor allergens on the development of systemic adverse reactions to subcutaneous immunotherapy. Conclusion:The present study suggests that SCIT was a safe treatment with a low risk to elicit severe systemic reaction, in which no fatality was observed. Furthermore, this study indicated that mold, HDM, asthma, presence of asthma and allergic rhinitis (AR), polysensitisation, and indoor allergens sensitization were a risk factors contributing to systemic reactions. consents were obtained from all patients (or their parents for children) before the initiation of immunotherapy and the guidelines were followed to monitor patients during allergen extract injection. Systemic Adverse Reaction to Specific ImmunotherapyThe adverse reaction observed during the administration of subcutaneous immunotherapy within a period of 9 years (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008), was analyzed in this study. Demographic and clinical data and peak expiratory flow before and after injection were recorded by the investigators on a standardized form. Immunotherapy scheduleImmunotherapy was given in term of conventional schedule. Conventional Immunotherapy build-up was typically given as injection per week until the maintenance dose wa...

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supporting

confidence: 49%

mentioning

confidence: 99%

Systemic Adverse Reaction to Specific Immunotherapy

Alsamarai¹,

Alobaidi²,

Alwan³

et al. 2011

J Aller Ther

View full text Add to dashboard Cite

show abstract

“…[65][66][67][68] In detail, it was reported that levocetirizine decreased the rate of SSR 68 and fexofenadine decreased the rate of LLR and cutaneous SSR 67 (Table 3). Importantly, effectiveness of VIT was not negatively influenced.…”

Section: Preventive Pretreatmentmentioning

confidence: 95%

“…Importantly, effectiveness of VIT was not negatively influenced. 68,69 Antihistamines were usually administered 1-2 h before the injections or sometimes twice daily. In case of repeated adverse events during updosing, pretreatment with omalizumab may be recommended.…”

Section: Preventive Pretreatmentmentioning

confidence: 99%

EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

Sturm

Varga

Roberts

et al. 2017

Allergy

382

528

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Hymenoptera venom allergy is a potentially life‐threatening allergic reaction following a honeybee, vespid, or ant sting. Systemic‐allergic sting reactions have been reported in up to 7.5% of adults and up to 3.4% of children. They can be mild and restricted to the skin or moderate to severe with a risk of life‐threatening anaphylaxis. Patients should carry an emergency kit containing an adrenaline autoinjector, H1‐antihistamines, and corticosteroids depending on the severity of their previous sting reaction(s). The only treatment to prevent further systemic sting reactions is venom immunotherapy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Venom Immunotherapy as part of the EAACI Guidelines on Allergen Immunotherapy initiative. The guideline aims to provide evidence‐based recommendations for the use of venom immunotherapy, has been informed by a formal systematic review and meta‐analysis and produced using the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included representation from a range of stakeholders. Venom immunotherapy is indicated in venom‐allergic children and adults to prevent further moderate‐to‐severe systemic sting reactions. Venom immunotherapy is also recommended in adults with only generalized skin reactions as it results in significant improvements in quality of life compared to carrying an adrenaline autoinjector. This guideline aims to give practical advice on performing venom immunotherapy. Key sections cover general considerations before initiating venom immunotherapy, evidence‐based clinical recommendations, risk factors for adverse events and for relapse of systemic sting reaction, and a summary of gaps in the evidence.

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“…The response to rApi m 2 was not significant. Phenotype B includes patients who might benefit from specific interventions from early on, such as premedication during bVIT (which has already been proposed as a means of achieving better tolerance [27][28][29]), different build-up phases, or use of higher venom doses [30].…”

Section: Clinical Changes Bvit Safetymentioning

confidence: 99%

IgE-Api m 4 Is Useful for Identifying a Particular Phenotype of Bee Venom Allergy

Ruiz¹,

Serrano²,

Moreno‐Aguilar³

2016

J Investig Allergol Clin Immunol

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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.

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Clinical and immunologic effects of H1 antihistamine preventive medication during honeybee venom immunotherapy

Cited by 86 publications

References 32 publications

Systemic Adverse Reaction to Specific Immunotherapy

Systemic Adverse Reaction to Specific Immunotherapy

EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

IgE-Api m 4 Is Useful for Identifying a Particular Phenotype of Bee Venom Allergy

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