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.

1.
Boyle RJ, Elremeli M, Hockenhull J, Cherry MG, Bulsara MK, Daniels M, Oude Elberink JN: Venom immunotherapy for preventing allergic reactions to insect stings. Cochrane Database Syst Rev 2012;10:CD008838.
2.
Ruëff F, Przybilla B: Venom immunotherapy: adverse reactions and treatment failure. Curr Opin Allergy Clin Immunol 2004;4:307-311.
3.
Cichocka-Jarosz E, Sanak M, Szczeklik A, Brzyski P, Gielicz A, Pietrzyk JJ: Serum tryptase level is a better predictor of systemic side effects than prostaglandin D2 metabolites during venom immunotherapy in children. J Investig Allergol Clin Immunol 2011;21:260-269.
4.
Golden DB, Demain J, Freeman T, Graft D, Tankersley M, Tracy J, Blessing-Moore J, Bernstein D, Dinakar C, Greenhawt M, et al: Stinging insect hypersensitivity: a practice parameter update 2016. Ann Allergy Asthma Immunol 2017;118:28-54.
5.
Pitsios C, Demoly P, Bilò MB, Gerth van Wijk R, Pfaar O, Sturm GJ, Rodriguez del Rio P, Tsoumani M, Gawlik R, Paraskevopoulos G, et al: Clinical contraindications to allergen immunotherapy: an EAACI position paper. Allergy 2015, 70:897-909.
6.
Ruëff F, Przybilla B, Bilò MB, Müller U, Scheipl F, Aberer W, Birnbaum J, Bodzenta-Lukaszyk A, Bonifazi F, Bucher C, et al: Predictors of side effects during the buildup phase of venom immunotherapy for Hymenoptera venom allergy: the importance of baseline serum tryptase. J Allergy Clin Immunol 2010;126:105-111.e5.
7.
Brown SG: Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol 2004;114:371-376.
8.
Goldberg A, Yogev A, Confino-Cohen R: Three days rush venom immunotherapy in bee allergy: safe, inexpensive and instantaneously effective. Int Arch Allergy Immunol 2011;156:90-98.
9.
Goldberg A, Confino-Cohen R: Rush venom immunotherapy in patients experiencing recurrent systemic reactions to conventional venom immunotherapy. Ann Allergy Asthma Immunol 2003;91:405-410.
10.
Awai LE, Mekori YA: Insect sting anaphylaxis and beta-adrenergic blockade: a relative contraindication. Ann Allergy 1984;53:48-49.
11.
Ingall M, Goldman G, Page LB: Beta-blockade in stinging insect anaphylaxis. JAMA 1984;251:1432.
12.
Kivity S, Yarchovsky J: Relapsing anaphylaxis to bee sting in a patient treated with beta-blocker and Ca blocker. J Allergy Clin Immunol 1990;85:669-670.
13.
Bernkopf K, Rönsch H, Spornraft-Ragaller P, Neumeister V, Bauer A: Safety and tolerability during build-up phase of a rush venom immunotherapy. Ann Allergy Asthma Immunol 2016;116:360-365.
14.
Müller UR, Haeberli G: Use of beta-blockers during immunotherapy for Hymenoptera venom allergy. J Allergy Clin Immunol 2005;115:606-610.
15.
Stoevesandt J, Hosp C, Kerstan A, Trautmann A: Hymenoptera venom immunotherapy while maintaining cardiovascular medication: safe and effective. Ann Allergy Asthma Immunol 2015;114:411-416.
16.
Hiatt WR, Stoll S, Nies AS: Effect of beta-adrenergic blockers on the peripheral circulation in patients with peripheral vascular disease. Circulation 1985;72:1226-1231.
17.
Jacobs RL, Rake GW Jr, Fournier DC, Chilton RJ, Culver WG, Beckmann CH: Potentiated anaphylaxis in patients with drug-induced beta-adrenergic blockade. J Allergy Clin Immunol 1981;68:125-127.
18.
Newman BR, Schultz LK: Epinephrine-resistant anaphylaxis in a patient taking propranolol hydrochloride. Ann Allergy 1981;47:35-37.
19.
Hermann K, Ring J: The renin-angiotensin system in patients with repeated anaphylactic reactions during hymenoptera venom hyposensitization and sting challenge. Int Arch Allergy Immunol 1997;112:251-256.
20.
Hermann K, von Tschirschnitz M, Ebner von Eschenbach C, Ring J: Histamine, tryptase, norepinephrine, angiotensinogen, angiotensin-converting enzyme, angiotensin I and II in plasma of patients with hymenoptera venom anaphylaxis. Int Arch Allergy Immunol 1994;104:379-384.
21.
Ruëff F, Vos B, Oude Elberink J, Bender A, Chatelain R, Dugas-Breit S, Horny HP, Küchenhoff H, Linhardt A, Mastnik S, et al: Predictors of clinical effectiveness of Hymenoptera venom immunotherapy. Clin Exp Allergy 2014;44:736-746.
22.
Cox L: Advantages and disadvantages of accelerated immunotherapy schedules. J Allergy Clin Immunol 2008;122:432-434.
23.
Confino-Cohen R, Rosman Y, Goldberg A: Rush venom immunotherapy in children. J Allergy Clin Immunol Pract 2017;5:799-803.
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.