Rush Venom Immunotherapy in Children

Confino‐Cohen, Ronit; Rosman, Yossi; Goldberg, Arnon

doi:10.1016/j.jaip.2016.10.011

Cited by 26 publications

(36 citation statements)

References 15 publications

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“…It slightly exceeds the values reported by Konstaninou et al and Nittner-Marszalska et al (3.7% respectively) [12, 18]. The higher rates described by Köhli-Wiesner et al (16%), Birnbaum et al (10.8%), and, most recently, by Confino-Cohen et al (19%) might be attributed to high proportions of bee venom allergic children [15–17]. …”

Section: Discussionmentioning

confidence: 74%

“…VIT itself, however, is a potential elicitor of anaphylactic side effects, which are most likely to occur during the dose increase phase [24–27]. As opposed to ample data derived from adult populations, there is a paucity of studies examining the safety of VIT in children [12, 15–18]. Our present study including a total of 1052 individuals, 71 of whom were pediatric patients, was designed to compare VIT-related adverse reaction rates in children and adults and to assess age-specific clinical parameters.…”

Section: Discussionmentioning

confidence: 99%

“…The authors of two recent studies demonstrate a reasonable efficacy of 50 µg maintenance doses in children and therefore advocate the use of reduced doses in order to improve the safety while decreasing the costs of treatment [12, 13]. Given the good tolerability of 100 µg doses in children and the clear dose-dependency of VIT [31], we and others opt for the use of standard dose increase protocols with a target dose of 100 µg in pediatric patients [15, 16, 18]. …”

Section: Discussionmentioning

confidence: 99%

“…There are, however, a surprisingly small number of studies addressing the safety of VIT in pediatric patients [12, 15–18], and even fewer including a direct comparison to adults [17, 18]. We aimed to assess the inpatient buildup phase of VIT using 3- or 5-day rush protocols in a cohort of pediatric patients, to examine the incidence of VIT-induced adverse reactions compared to a large and homogeneous adult control group and to work out age-specific characteristics.…”

Section: Introductionmentioning

confidence: 99%

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Safety of 100 µg venom immunotherapy rush protocols in children compared to adults

Stoevesandt

Hosp

Kerstan

et al. 2017

Allergy Asthma Clin Immunol

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BackgroundThere is a paucity of studies examining the safety of venom immunotherapy (VIT) in children. We aimed to assess the incidence of anaphylactic side effects during rush VIT in a cohort of pediatric patients and adult controls.Methods72 consecutive cycles of VIT-buildup in 71 children/adolescents aged 7–17 years were retrospectively evaluated and compared to an adult control group (n = 981) with regard to baseline parameters (sex, causative venom, severity of index sting reaction, results of allergy testing, comorbidities) and the incidence of anaphylactic adverse reactions.ResultsCompared to adults, severe index sting-induced anaphylaxis was significantly less common in children (P = .001). Children were more likely to suffer from bee venom allergy (P < .001) and showed higher levels of bee venom-specific IgE (P = .013), but lower serum tryptase concentrations (P = .014). The overall rate of VIT-induced anaphylactic reactions was higher in children than in adults (6.9% vs 2.5%, P = .046 by univariate analysis). In the final binary logistic regression model, however, only bee VIT (P = .039; odds ratio 2.25; confidence interval 1.04–4.87) and 5-day compared to 3-day buildup protocols (P = .011; odds ratio 2.64; confidence interval 1.25–5.57) were associated with an increased risk of treatment-induced anaphylaxis. All pediatric patients finally reached and tolerated the target maintenance dose of 100 µg.ConclusionsThe higher anaphylactic reaction rate observed in pediatric patients may be attributed to a greater prevalence of bee venom allergy. VIT-induced anaphylaxis in children is usually mild and does not affect further updosing and maintenance of VIT.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Safety of 100 µg venom immunotherapy rush protocols in children compared to adults

Stoevesandt

Hosp

Kerstan

et al. 2017

Allergy Asthma Clin Immunol

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“…Others found that RVIT was as safe as CVIT, especially in vespid venom allergy [22]. We have demonstrated in the past the safety and efficiency of our rush build-up protocol in the general population as well as in children, including very young children, when most of the patients were allergic to BV [8,23]. Thus, in accordance with our previous findings, the current study also found a lower incidence of SR per injection in patients receiving RVIT compared to CVIT despite the fact that all of the patients with a high baseline tryptase level, which is known to be a major risk factor for VIT- ISR, were in the RVIT group.…”

Section: Discussionmentioning

confidence: 80%

Venom Immunotherapy in High-Risk Patients: The Advantage of the Rush Build-Up Protocol

Rosman

Confino‐Cohen²,

Goldberg³

2017

Int Arch Allergy Immunol

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Background: Venom immunotherapy (VIT) is considered to be the gold standard treatment for patients with hymenoptera venom allergy. This treatment induces systemic reactions (SR) in a significant number of patients. Objective: To evaluate the outcome of VIT in patients with known risk factors for VIT-induced SR and to compare rush VIT (RVIT) and conventional VIT (CVIT). Methods: All of the patients who received VIT and had at least one of the following risk factors were included: current cardiovascular disease, uncontrolled asthma, high basal serum tryptase, current treatment with β-blockers or angiotensin-converting enzyme inhibitors, and age >70 or <5 years. Results: Sixty-four patients were included, and most of them (52; 81.5%) were allergic exclusively to bee venom. Thirty-five (54.7%) patients underwent RVIT and 29 CVIT. The incidence of patients who developed SR during the build-up phase was similar for RVIT and CVIT (25.7 and 27.5%, respectively; p = 1). However, the incidence of SR per injection was significantly higher in CVIT than in RVIT (5.6 and 2.75%, respectively; p = 0.01). Most reactions (79.1%) were mild, limited to the skin. Most of the patients (92.1%) reached the full maintenance dose of 100 μg. This dose was reached by a significantly larger number of patients receiving RVIT compared to CVIT (100 and 82.7%, respectively; p = 0.01). None of the patients experienced exacerbation of their concurrent chronic disease during VIT. Conclusion: VIT can be performed safely and efficiently in patients with risk factors for immunotherapy. In these patients RVIT appears to be safer and more efficient than CVIT.

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Updates and Recent Advances on Venom Immunotherapy

Floyd

Adams

Golden

2023

Curr Treat Options Allergy

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Purpose of Review Venom immunotherapy has been utilized to treat Hymenoptera venom allergy since the 1920s. Over the last century, significant advances in the fields of immunology and genetics have led to improvements in the practice of venom immunotherapy. This review encompasses recent advances in the use of venom immunotherapy to provide precise, patient-centered care. Recent Findings Research about the mechanism of action of venom immunotherapy continues to highlight the modification of both the innate and adaptive immune systems. Molecular techniques have allowed for the identification of specific venom allergens to improve the diagnostic accuracy and safety of venom immunotherapy. Research continues to support the safety of accelerated schedules which can impact the cost, adherence, and quality of life for patients receiving this treatment modality. Finally, significant advances have led to the elucidation of risk factors that place patients at risk for reactions during and after venom immunotherapy. Creation of risk profiles for venom-allergic patients can thus inform the process of immunotherapy in order to provide personalized and precise care. Summary Significant progress in the use of venom immunotherapy makes the practice a dynamic and active field for continued research. Future research needs to build on these recent advances to continue to optimize and enhance this life-saving treatment.

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Rush Venom Immunotherapy in Children

Cited by 26 publications

References 15 publications

Safety of 100 µg venom immunotherapy rush protocols in children compared to adults

Safety of 100 µg venom immunotherapy rush protocols in children compared to adults

Venom Immunotherapy in High-Risk Patients: The Advantage of the Rush Build-Up Protocol

Updates and Recent Advances on Venom Immunotherapy

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