Hymenoptera Venom Immunotherapy: Tolerance and Efficacy of an Ultrarush Protocol versus a Rush and a Slow Conventional Protocol

Abstract

Background and Objective. Various venom immunotherapy (VIT) protocols are available for Hymenoptera allergy. Although adverse reactions (ADRs) to VIT are widely reported, controlled trials are still needed. We conducted a randomized prospective study to evaluate ADRs and the efficacy of three VIT regimens. Methods. 76 patients with Hymenoptera allergy, aged 16–76 years, were randomized to receive an ultrarush protocol (group A: 27 patients), a rush protocol (group B: 25), or a slow protocol (group C: 24). Aqueous venom extract was used in incremental phase and an adsorbed depot in maintenance phase. ADRs and accidental Hymenoptera stings during VIT were used to evaluate efficacy. Results. During incremental treatment, ADRs occurred in 1.99%, 3.7%, and 3.9% of patients in groups A, B, and C, and in 0.99%, 1.46%, and 2.7%, respectively, during maintenance. ADRs were significantly fewer in group A (incremental + maintenance phase) than in group C (1.29% versus 3.2%; P = 0.013). Reactions to accidental Hymenoptera stings did not differ among groups (1.1%, 1.2%, and 1.1%). Conclusion. Ultrarush was as effective as the rush and slow protocols and was associated with a low incidence of reactions to stings. This study indicates that ultrarush VIT is a valid therapeutic option for Hymenoptera allergy.

Hymenoptera Venom Allergy: Management of Children and Adults in Clinical Practice

“…In a recent Cochrane Review, the percentage of nonprotection was 2.7% in treated patients compared with 39.8% in patients not undergoing immunotherapy [156]. Regarding vespid venom, protection is between 91% and 96%, while for bee venom it ranges between 77% and 84% [14,90,[157][158][159][160][161][162][163][164][165][166][167]. Studies performed on European populations, including Italian cases, show that about 70% of treated patients are allergic to vespids [164,166].…”

“…However, some authors do not consider rush or ultrarush induction protocols to be dangerous, since they were able to demonstrate a low risk of systemic reactions and a safety profile equivalent to or even better than slower protocols [163,[209][210][211].…”

Insect Venom Immunotherapy: Analysis of the Safety and Tolerance of 3 Buildup Protocols Frequently Used in Spain

“…Few prospective studies have compared buildup protocols of venom immunotherapy [7][8][9][10], and no studies to date have compared a conventional 9-week protocol with clustered 3-and 4-week protocols. Buildup protocols are difficult to compare given the many differences between them (eg, patients selected, protocols used, extracts, and recording of adverse reactions), thus no doubt explaining why the prevalence of systemic reactions reported in the literature is so variable, ranging from 2% [11] to 21% [12].…”

“…Standard protocols (lasting 8-15 weeks), rush protocols (4-7 days), and ultrarush protocols (1-2 days) can all be used. Ultrarush protocols have been shown to be safe [9,12,[15][16][17]; however, other prospective studies have shown a rapid increase in dose to be an independent risk factor for adverse systemic reactions [13,18]. In the case of ultrarush protocols, this risk is increased 1.8-fold, although the protocols are costeffective [19,20].…”

Treatment of Hymenoptera venom allergy

“…A lower, 50 mg dose of venom (not commercially available for jumper jack ant) in this experimental study [39] was associated with fewer SARs, but there were concerns about optimal efficacy using this dose. However, Patella et al [40] found that individuals randomized to an ultrarush protocol using either honeybee or yellow-jacket venoms did not have a significantly higher number of SARs during buildup or maintenance compared with those who received rush or standard buildup protocols. Ultrarush protocols also are effective in children but are associated with a significant risk of SARs.…”