Immunotherapy with Hymenoptera venoms

Abstract

Immunotherapy with Hymenoptera venoms is widely used throughout the world and is accepted as an effective treatment for most patients with Hymenoptera venom allergy. There are, however, still some unresolved problems with this form of treatment. At present there is no definite test which makes it possible to identify patients at risk ‐ and thus candidates for immunotherapy ‐ unequivocally. On the basis of prospective studies on the natural history of Hymenoptera allergy, venom immunotherapy is indicated in adults with severe systemic anaphylaxis. It is usually not necessary in patients with large local reactions only. Children with mild systemic reactions, e.g. urticaria, will need immunotherapy only in case of repeated reactions and/or a high risk of re‐exposure. The selection of venoms for immunotherapy may lead to some confusion owing to common antigenic determinants shared by venoms of various Hymenoptera species. Many different regimens for immunotherapy have been proposed. At present, the three main are: rush, stepwise or clustered and classical. The maintenance dose of 100 μg usually protects from life‐threatening reactions. However, in some patients 200 μg are necessary for complete protection. The usual interval between maintenance injections is 4 to 6 weeks. In many patients a strong increase of venom specific serum IgG‐antibodies usually parallels clinical protection induced by venom immunotherapy, although many exceptions have been reported. Allergic side effects of venom immunotherapy are not rare, especially with honey bee venom and during the initial phase of dose increase. The question of the duration of venom immunotherapy is handled differently: although some authors recommend treatment for life, most suggest treating patients until skin tests and RAST become negative.

Carbohydrate epitopes as a cause of cross-reactivity in patients allergic to Hymenoptera venom

“…True double sensitization and also cross-reactivity must be considered as causes of the double positivity in this group of patients [1]. Cross-reactivity of venom hyaluronidases and with carbohydrate epitopes is known [2,3], and distinguishing between double sensitization and cross-reactivity is crucial in the choice of allergen for specific immunotherapy in patients who did not recognize the culprit insect [4]. If double sensitization is proven, immunotherapy with both venoms is required; if cross-reactivity is the case, only the venom that caused sensitization should be used [1].…”

Allergy Vaccine Engineering: Epitope Modulation of Recombinant Bet v 1 Reduces IgE Binding but Retains Protein Folding Pattern for Induction of Protective Blocking-Antibody Responses

“…Controlled studies have shown efficacy in patients with allergic rhinitis/conjunctivitis, allergic asthma, and allergic reactions from stinging insects (1,2). Effective treatment is correlated with the use of standardized vaccines in maintenance doses containing 5-20 g of major allergen for 3-5 years (3).…”

Safety and efficacy of venom immunotherapy: a real life study

“…Unfortunately, VIT may be associated with a risk of adverse events [7]. We have found that side effects during VIT are quite frequent (reported by 43.8% of patients in our cohort).…”

“…As a consequence, a limited access to this life-saving procedure may be seen. What is striking, a high level of variations (0–46%) and inconsistency in the side-effects frequency is reported in the literature [7–10]. Moreover, there are just a few comprehensive studies dedicated to this topic [11–16].…”