Risk Assessment of Hymenoptera Re-Sting Frequency: Implications for Decision-Making in Venom Immunotherapy

Moos, Seraina von; Graf, Nicole; Johansen, Pål; Müllner, G.; Kündig, Thomas M.; Senti, Gabriela

doi:10.1159/000338942

Cited by 22 publications

(10 citation statements)

References 50 publications

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“…A prevalence of insect sting allergies of up to 43% has been reported in selected populations and probably varies with exposure, as determined by climate and activities [3,9]. Few general population studies have been performed.…”

Section: Discussionmentioning

confidence: 99%

Insect Sting Reactions and Specific IgE to Venom and Major Allergens in a General Population

Mosbech

Tang²,

Linneberg³

2016

Int Arch Allergy Immunol

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Background: Insect sting reactions are frequently reported, but population studies documenting the frequency and the relation to IgE-sensitization and serum tryptase are scarce. Methods: Questionnaire data and results from measurements of specific IgE against venom, major allergens and cross-reacting carbohydrate determinants (CCDs) were collected from 2,090 adult participants in a cross-sectional survey. Results: 13% of the population reported symptoms of sting reactions and about half were systemic in nature. In all, 15% were sensitized to venom but only 31% of these had reacted to stings and only 38% of those with reactions had IgE to venom. In addition, 12% with IgE to venom were double-sensitized (DS), i.e. to both bee and wasp venom. Among DS IgE to major venom allergens, rApi m 1, rVes v 1 and rVes v 5 were negative and of no help in 31%, but 59% could be identified as likely sensitized to bee or wasp. IgE to CCDs occurred in only 0.7%, but 80% of these were DS. Finally, 36% with IgE to CCDs had had symptoms, mostly local. Serum tryptase was not associated with a history of sting reactions. Conclusions: In a temperate climate, self-reported insect sting reactions and sensitization to venom are frequent, but in most cases, these are not seen in the same individual. In DS individuals, measurements of IgE to major allergens can be helpful in some but not all cases and additional analyses are needed. IgE to CCDs may have some clinical relevance.

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Section: Discussionmentioning

confidence: 99%

Insect Sting Reactions and Specific IgE to Venom and Major Allergens in a General Population

Mosbech

Tang²,

Linneberg³

2016

Int Arch Allergy Immunol

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“…One year of VIT did not provide sufficient protection in about a quarter of treated patients [188]. After 3 years of VIT, 83% to 100% of patients remain protected against subsequent stings for a further 1 to 3 years [158,159,188,[189][190][191][192][193].…”

Section: High Tryptase Valuesmentioning

confidence: 97%

“…Given its degree of effectiveness, VIT is also recommended for moderate systemic reactions to enable the worker at risk to continue working [14,190,257,262].…”

Section: Professional Aspectsmentioning

confidence: 99%

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

Bilò

Pravettoni

Bignardi

et al. 2019

J Investig Allergol Clin Immunol

115

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Hymenoptera venom allergy is an epidemiologically underestimated condition representing an important cause of morbidity worldwide. Preventing future allergic reactions in patients who have developed a systemic reaction is based on the correct management of emergency followed by a correct diagnosis, prescription of adrenaline autoinjectors and, where indicated, specific venom immunotherapy (VIT). Some epidemiological studies highlight the poor knowledge of this disease and the frequent inadequacy of its management. Moreover, they emphasize the importance of such a life-saving treatment as specific immunotherapy. The availability of high quality Hymenoptera venom extracts for diagnostic and therapeutic use has dramatically improved the prognosis and the quality of life of allergic patients. The subcutaneous VIT represents the most effective form of immunotherapy with allergen presently available, with a carry-over effect lasting up to several years after its interruption. This report on the management of children and adults allergic to Hymenoptera venom was drawn up by a panel of Italian experts. The main objective of this consensus is to review the scientific evidences related to diagnosis, therapy and management of patients allergic to Hymenoptera venom and is aimed to improve the knowledge about this disease and promote good clinical practices. Practical suggestions for a correct diagnosis, prescription of emergency therapy and immunotherapy, as well as strategies for taking care of patients´ management are included.

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“…Avoidance measures are the cornerstone of prevention; however, these measures are sufficient in less than one half of patients -specifi-cally, in those with low exposure to hymenoptera stings. Von Moos et al [14] retrospectively analyzed the re-sting data of 96 bee venom-allergic and 95 vespid venom-allergic patients. They showed that the benefits of VIT are greater in subjects with higher exposure to further stings.…”

Section: Discussionmentioning

confidence: 99%

Benefits of venom immunotherapy: How soon can they be expected

Kadivec

Košnik

2017

Srp Arh Celok Lek

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Introduction/Objective Allergic reactions to insect stings are medical emergencies that could be prevented by venom immunotherapy (VIT). The main purpose of VIT is to prevent fatal or life-threatening reactions. We aimed to show the rapidity with which patients experience the benefits of VIT and estimate the number of emergency treatments that are prevented. Methods We reviewed the medical files of patients who started VIT between 2010 and 2014. We calculated the costs of treatment of the sting reactions, the costs of immunotherapy, and estimated the costs of prevented allergic reactions. Results In a cohort of 514 patients (40.9% female, age 47.2 ± 14.4 years), the cost of treatment of the index sting reaction was 180.4 ± 166.8 euros. During VIT, patients experienced 446 field stings. In 86.3% of patients, stings were well tolerated, and only one patient experienced a severe reaction (grade III, according to Mueller). A total of 20.4% of VIT treated patients were stung during the first year of VIT and 57% during five years of VIT. The expenditure for five years of VIT was 2,886 euros per patient, which corresponded to an average of 16 emergency treatments for systemic reactions. Conclusion Emergency situations are prevented in a substantial number of venom-allergic patients and a beneficial effect was already observed during the first year of VIT.

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Risk Assessment of Hymenoptera Re-Sting Frequency: Implications for Decision-Making in Venom Immunotherapy

Cited by 22 publications

References 50 publications

Insect Sting Reactions and Specific IgE to Venom and Major Allergens in a General Population

Insect Sting Reactions and Specific IgE to Venom and Major Allergens in a General Population

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

Benefits of venom immunotherapy: How soon can they be expected

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