Long-Term Follow-Up of Children after Venom Immunotherapy: Low Adherence to Anaphylaxis Guidelines

Abstract

Background: Data on the long-term outcome of children after specific venom immunotherapy (VIT) are limited. Therefore, we assessed sting recurrence and anaphylaxis relapse rates as well as adherence to anaphylaxis guidelines with regard to the availability of emergency equipment and education status. Methods: For this long-term survey, data of 311 children with a history of anaphylactic reactions to hymenoptera stings were collected by chart review. We included patients who were treated with a 3-year VIT between 1993 and 2009 and had completed a questionnaire. Results: Forty of the 311 patients were included. Mean VIT duration was 3.1 years. Of the 40 patients included, 29 children (72.5%) received VIT with vespid venom, 9 with bee venom, and 2 patients with both venoms. During a mean follow-up period of 13 years, 20/40 patients (50%) suffered re-stings. Six of the 20 (30%) patients developed again anaphylactic symptoms (grade 1 n = 5, grade 3 n = 1); 2 were allergic to vespid and 4 to bee venom. Of the entire cohort, only 5/40 (12.5%) had appropriate emergency kits according to the guidelines of the European Academy of Allergy and Clinical Immunology. Among the patients who had emergency kits available, one third (5/15) felt uncertain about the correct application of the medication. Less than two thirds of our population (25/40) affirmed that they have been educated in emergency management. The vast majority (95%; 38/40) of our patients did not have allergy follow-ups after VIT completion. Conclusions: Anaphylactic relapses are not uncommon, and there are considerable deficits in the emergency management of patients. Hence, comprehensive standardized anaphylaxis education programs as well as regular follow-ups of the allergy status are crucial.

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

“…Among 40 children who received VIT for a mean of 3 years, 50% developed a new anaphylactic reaction after a median follow-up of 13 years; of note, 95% had not received adequate follow-up after discontinuation of VIT [242].…”

Clinical aspects of hymenoptera venom allergy and venom immunotherapy

“…According to recent guidelines, the recommended duration of VIT is 3-5 years in both adults and children (32,93). It is estimated that, after the third year of VIT, 83-100% of patients are protected from further SR upon stinging, and such protection usually lasts for 1-3 years after discontinuation; however, long lasting results are more likely to be obtained after at least 5 years of treatment (32,94,95). In selected cases (i.e.…”

Hymenopterengiftallergie – Wer kann wann sein Notfallset ablegen oder lieber nicht?

“…Hymenopterengiftallergien (HGA) gehören zu den häufigsten Auslösern der Anaphylaxie und sind potenziell lebensbedrohlich [1,2]. Die Erstlinientherapie bei schweren Soforttypreaktionen besteht in der Gabe von intramuskulärem Adrenalin [3].…”