Background: The safety profile of venom immunotherapy is a relevant issue. We evaluated the frequency of severe adverse events (SAE), associated risk factors, retrospective comparison of pretreatment protocols including solely H1 receptor blockers and a combination of H1 and H2 receptor blockers during rush Hymenoptera venom immunotherapy. Methods: The study group comprised 118 patients. The treatment was initiated according to a 5-day rush protocol with the use of standardized venom allergens of either wasp or honeybee. Results: During the rush induction, side effects occurred in 18 patients (15.2%), whereas SAE were present in 7 patients (5.9%). Twelve out of 18 (66.6%) developed anaphylactic reactions on the fourth day of the rush protocol, with the majority of cases at a dose of 40 or 60 µg of the venom extract (p = 0.001). The frequency of SAE was also significantly higher on the fourth day than thereafter (p = 0.0001) as well as in patients allergic to bee venom (p = 0.049). All systemic side effects were more frequent in women (p = 0.0065). However, this relation was not true when SAE were consider (p = 0.11). A higher percentage of SAE was observed in the subjects pretreated with both H1 and H2 receptor antagonists than in those pretreated with H1 blocker only (8.8 vs. 4.1%); however, the difference was not significant. Conclusions: Considerable severity of allergic adverse events requires particular attention to patients allergic to bee venom and during rush phase, especially when rapidly increasing doses are administered. Pretreatment with H2 blockers is debatable and warrants further investigation.

Golden DBK: Insect sting allergy and venom immunotherapy: a model and a mystery. J Allergy Clin Immunol 2005;115:439–447.
Muller U, Mosbech H, Blaauw P, Dreborg S, Malling HJ, Przybilla B, et al: Emergency treatment of allergic reactions to Hymenoptera stings. Clin Exp Allergy 1991;21:281–288.
Charpin D, Birnbaum J, Vervloet D: Epidemiology of hymenoptera allergy. Clin Exp Allergy 1994;24:1010–1015.
Novembre E, Cianferoni A, Bernardini R, Veltroni M, Ingargiola A, Lombardi E, et al: Epidemiology of insect venom sensitivity in children and its correlation to clinical and atopic features. Clin Exp Allergy 1998;28:834–838.
Annila I: Bee venom allergy. Clin Exp Allergy 2000;30:1682–1687.
Nittner-Marszalska M, Liebhart J, Liebhart E, Dor A, Dobek R, Obojski A, et al: Prevalence of Hymenoptera venom allergy and its immunological marker current in adults in Poland. Med Sci Monit 2004;10:324–329.
Gawlik R, Nittner-Marszalska M: Allergology in Practice. Łódź, Mediton, 2003.
Ross RN, Nelson HS, Finegold J: Effectiveness of specific immunotherapy in the treatment of Hymenoptera venom hypersensitivity. A meta-analysis. Clin Ther 2000;22:351–358.
Mosbech H, Muller U: Side-effects of insect venom immunotherapy: results from an EAACI multicenter study. European Academy of Allergology and Clinical Immunology. Allergy 2000;55:1005–1010.
Wolf BL, Hamilton RC: Near-fatal anaphylaxis after Hymenoptera venom immunotherapy. J Allergy Clin Immunol 1998;102:527–528.
Poli F, Long G, Parmiami S: The safety and efficacy of immunotherapy with aluminum hydroxide-adsorbed venom extract of Vespula spp. An open, retrospective study. Hymenoptera Allergol Immunopathol 2001;29:191–196.
Westall GP, Thien FC, Czarny D, O’Hehir RE, Douglas JA: Adverse events associated with rush Hymenoptera venom immunotherapy. Med J Aust 2001;174:227–230.
Mueller HL: Insect allergy. Pediatr Clin North Am 1959;6:917–952.
Sturm G, Kranke B, Rudolph C, Aberer W: Rush hymenoptera venom immunotherapy: a safe and practical protocol for high-risk patients. J Allergy Clin Immunol 2002;110:928–933.
Bonifazi F, Jutel M, Bilo BM, Birnbaum J, Muller U: Prevention and treatment of hymenoptera venom allergy: guidelines for clinical practice. Allergy 2005;60:1459–1470.
Laurent J, Smiejan JM, Bloch-Morot E, Herman D: Safety of Hymenoptera venom rush immunotherapy. Allergy 1997;52:94–96.
Wenzel J, Meissner-Kraemer M, Bauer R, Bieber T, Gerdsen R: Safety of rush insect venom immunotherapy. The results of a retrospective study in 178 patients. Allergy 2003;58:1176–1179.
Brehler R, Wolf H, Kutting B, Schnitker J, Luger T: Safety of a two-day ultrarush insect venom immunotherapy protocol in comparison with protocols of longer duration and involving a larger number of injections. J Allergy Clin Immunol 2000;105:1231–1235.
Birnbaum J, Ramadour M, Magnan A, Vervloet D: Hymenoptera ultra-rush venom immunotherapy (210 min): a safety study and risk factors. Clin Exp Allergy 2003;33:58–64.
Brockow K, Kiehn M, Riethmuller C, Vieluf D, Berger J, Ring J: Efficacy of antihistamine pretreatment in the prevention of adverse reactions to hymenoptera immunotherapy: a prospective, randomized, placebo-controlled trial. J Allergy Clin Immunol 1997;100:458–463.
Jutel M, Watanabe T, Klunker S, Akdis M, Thomet OA, Malolepszy J, et al: Histamine regulates T-cell and antibody responses by differential expression of H1 and H2 receptors. Nature 2001;413:420–425.
Przybilla B, Ring J, Griesshammer B, Braun-Falco O: Rush hyposensitization with Hymenoptera venoms. Tolerance and results of therapy. Dtsch Med Wochenschr 1987;112:416–424.
Berchtold E, Maibach R, Muller U: Reduction of side effects from rush-immunotherapy with honey bee venom by pretreatment with terfenadine. Clin Exp Allergy 1992;22:59–65.
Youlten LJ, Atkinson BA, Lee H: The incidence and nature of adverse reactions to injection immunotherapy in bee and wasp allergy. Clin Exp Allergy 1995;25:159–165.
Pasaoglu G, Sin BA, Misirligil Z: Rush hymenoptera venom immunotherapy is efficacious and safe. J Investig Allergol Clin Immunol 2006;16:232–238.
Jutel M, Akdis M, Blaser K, Akdis CA: Mechanisms of allergen specific immunotherapy – T-cell tolerance and more. Allergy 2006;61:796–807.
Muller U, Hari Y, Berchtold E: Premedication with antihistamines may enhance efficacy of specific-allergen immunotherapy. J Allergy Clin Immunol 2001;107:81–86.
Mingomataj E, Priftanji A, Qirko E, Dinh QT, Fischer A, Peiser C, et al: Specific immunotherapy in Albanian patients with anaphylaxis to hymenoptera venoms. BMC Dermatol 2002;2:11–16.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.