Specific immunotherapy in Albanian patients with anaphylaxis to hymenoptera venoms

Abstract

BackgroundSevere allergic reactions during rush-specific immunotherapy (Rush-SIT) may occur in the treatment of hymenoptera sting allergy. The objective of the present study was to examine the characteristics of allergic reactions during Rush-SIT in a cohort of patients with allergy towards hymenoptera venom in the mediterranean population of Albania.MethodsA retrospective study was performed using the clinical reports of 37 patients with venom of bee (apinae), wasp (vespidae, subfamily vespinae) or paperwasp (vespidae, subfamily polistinae) allergy treated with Rush-SIT between 1987 and 1996. After hymenoptera sting allergy diagnosis according to anamnesis and intracutaneous tests the patient were treated with Rush-SIT. The protocol lasted 3 – 4 d with an increase in the concentration from 0.01 μg/ml to 100 μg/ml. Anaphylactic reactions were classified according to the Mueller-classification.ResultsThe frequency of reactions during Rush-SIT for bee-venom was 4.7% and for wasp-venom was 1.5% (p < 0.01). The mean frequency of reactions of Mueller grade II for the bee-venom Rush-SIT patients during the first 4 d (= 26 injections) was 0.73 and for the wasp-venom Rush-SIT patients 0.15. No patient experienced a third-degree reaction. 94.6% of the patient supported an end dose of 100 μg.ConclusionsRush-SIT is a reliable method for the treatment of anaphylactic reactions to hymenoptera venom even in less developed countries. Bee-venom Rush-SIT was found to cause higher numbers allergic reactions than wasp or paperwasp Rush-SIT.

Peran Imunoterapi pada Alergi Sengatan Lebah

“…Kombinasi antagonis H1 dan antagonis H2 seperti simetidin dengan dosis 4 mg/kgBB memberikan hasil yang lebih baik. 1,2,5,6,12,14 Pengobatan topikal dengan krem kortikosteroid kurang efektif dan penggunaan antihistamin topikal dapat berpotensi timbulnya sensitisasi dan tidak berperan pada pengobatan alergi sengatan lebah. 4 Untuk pengobatan jangka panjang pada pasien dengan alergi sengatan lebah dapat dilakukan pengobatan secara imunologis yang efektif untuk mencegah reaksi alergi akibat sengatan lebah.…”

“…Tindakan ini paling sering dilakukan pada penyakit yang dimediasi antibodi IgE, namun dapat pula digunakan pula pada penyakit alergi lainnya. 1,2,5,6,10,20 Imunoterapi sebagai pengobatan penyakit alergi telah dilakukan pada awal dekade abad ke 20 (1911) saat Noon dan Freeman di St Mary Hospital, London, menggunakan ekstrak serbuk sari (pollen) pada pengobatan penyakit hay fever. Imunoterapi ini telah banyak dilakukan di Amerika Utara juga di Inggris.…”

“…Prevalensi reaksi alergi akibat sengatan lebah bervariasi antara 0,4 sampai 4% bahkan lebih, dengan angka mortalitasnya berkisar antara 0,09 sampai 0,45 per sejuta populasi setiap tahun. 2 Dilaporkan terjadinya reaksi anafilaksis selama 5 tahun pengamatan, 15% dari seluruh kasus disebabkan sengatan lebah. 3 Namun belum diperoleh angka laporan kasus tersebut di Indonesia.…”

Atividades biológicas de peçonhas de vespa (Polistes lanio lanio) e formiga (Paraponera clavata)

“…Vespas utilizam a peçonha para defesa, portanto quando ocorrem acidentes com envenenamento vespídeos onde os principais efeitos são reações alérgicas incluindo anafilaxia fatal (12,15). Além disso, o envenenamento pode causar a morte por hemólise intravascular, rabdomiólise, insuficiência renal aguda, disfunção hepática e, ocasionalmente, trombocitopenia e coagulopatia (163).…”

“…Já os efeitos sistêmicos incluem choque anafilático, resultante de reação de hipersensibilidade (11,12), cardiotoxicidade, hepatotoxicidade e nefrotoxicidade (13,14). Eventualmente, recomenda-se imunoterapia em pacientes com hipersensibilidade para reduzir o risco de respostas graves a picadas destes insetos (15,16).…”