Survey on practice of venom immunotherapy in France

Abstract

IntroductionVenom immunotherapy (VIT) is the only efficient prevention for sting-induced anaphylaxis, but its application is not without risks and needs precautions and standardization. European guidelines were proposed in 2005, but recent practice surveys and more recent knowledge raise the need for an update. The aim of this study was to analyze VIT practices in France, based on previous surveys in Europe but also extended to outcome event management.Material and methodsA paper questionnaire was sent widely to persons involved in venom treatment.ResultsEighty-six responses could be included from physicians actively involved in VIT induction evenly distributed in France. The survey shows that VIT was engaged from grade III down to grade I reactions, starting preferentially with the ultra-rush protocol. Premedication was used by 42% only and risks induced by co-treatment with β-blockers were well known but not with angiotensin-converting enzyme inhibitors. However, side effects were very variably managed from arrest to enhancement in doses, time-delay or duration. Similarly, we observed a large discrepancy in treatment evaluation (skin tests, biology, timing and interpretation), decision making for treatment termination (when and how long to be prolonged) and post-treatment follow-up (adrenaline kit, event record) as well as procedures in case of late relapse (new induction, different doses).ConclusionsOur study shows that most recommendations were fully or partially followed and may need reminding, but many points need to be completed or updated with new tools and knowledge acquired during the last 10 years.

Venom allergy treatment practices in Poland in comparison to guidelines: next edition of the national audit

“…Presented data represent nearly the whole population of specialists applying VIT in Poland. The data are discussed with reference to the previous and current EAACI guidelines (Table 4) as well as in comparison to the British, French and previous Polish studies [13–16]. The European guidelines are intended for all countries, which are members of the EAACI and thus it is a disappointment that such a small number of national reports exist on the correspondence of real-life practice with the guidelines.…”

“…In Poland we observed a growing preference for UpD immunotherapy ultrarush protocols (cumulative dose of 111.1 μg by Muller or of 101.1 μg by Birnbaum) [24, 25] (71% vs. 58% in 2009 [14]) as well as the lack in use of the conventional protocol. The UR protocol is the most commonly (60%) reported by the French authors [16], while in the UK the most common protocol remains the conventional one (76% vs. 92% during the previous study) [13, 15]. This difference may arise from the fact that in Poland, VIT is performed as an in-hospital procedure, in the UK it is an outpatient one, whereas in France, UpD is given in inpatient and continued in outpatient settings [15, 16].…”

“…The UR protocol is the most commonly (60%) reported by the French authors [16], while in the UK the most common protocol remains the conventional one (76% vs. 92% during the previous study) [13, 15]. This difference may arise from the fact that in Poland, VIT is performed as an in-hospital procedure, in the UK it is an outpatient one, whereas in France, UpD is given in inpatient and continued in outpatient settings [15, 16].…”

“…They concern the duration of the UR protocol (from 3 to 8 h) and the time interval between the completion of the UpD and the administration of the first dose of MD (from 7 to 35 days). Differentiation is common, for example, French authors reported one month between UpD and the first MD [16].…”

“…An up-date of the EAACI VIT recommendations has been published in 2018 year [11, 12]. Even though the present-day recommendations should guarantee the optimal procedures in the treatment of HVA, current analysis shows that the actual practices differ in some aspects [13–16].…”