Old Questions, new answers: real-world long-term efficiency of hymenoptera venom immunotherapy: prevalance of venom-induced anaphylaxis, risk factors, and field sting reactions
Main Article Content
Keywords
field sting, honeybee venom, venom immunotherapy, venom-induced anaphylaxis, vespid venom
Abstract
Background: Hymenoptera venom allergy is a potentially life-threatening allergic reaction. Venom immunotherapy (VIT) is recommended to prevent severe allergic reactions. Field stings indicate the effectiveness of immunotherapy.
Objective: The aim of this study was to investigate the prevalence of venom-induced anaphylaxis, risk factors, and field sting reactions during or after the completion of VIT.
Methods: In this study, the records of patients who underwent VIT between 2015 and 2023 at one of the largest referral hospitals in Turkey were retrospectively analysed. The protocol followed during the initiation of immunotherapy, adverse reactions, clinical characteristics of the patients (including demographic characteristics, allergic diseases, laboratory findings), and field sting reactions during and after completion of immunotherapy were analysed.
Results: A total of 194,526 unique patient files evaluated in the Allergy Outpatient Clinic between 2015 and 2023 were analysed. Of these, 384 patients were admitted with an allergic complaint following a bee sting. Among them, 113 patients (29.4%) were eligible for VIT. A total of 79 patients were included (F/M: 41/38). VIT was performed with honeybee venom in 39 patients, vespid venom in 36 patients, and both venoms in 4 patients. 62.0% (n=49) of the patients had been stung by a bee in the head and neck region. 69.6% (n=55) of the patients had a stage 3 reaction before VIT. The cluster scheme was applied to 54.4% (n=43) of all patients. There was no statistically significant difference in the number of field stings or the use of adrenaline autoinjectors between the VIT groups (p>0.05). Stage 3-4 reactions developed in 87.8% of patients stung in the head and neck region, compared to 53.3% of patients stung in other regions. During and after VIT, field stings were reviewed both from patient files and by follow-up inquiries during control visits. During VIT, field stings were observed in 19 patients. Systemic allergic reactions developed in 5 patients, and local allergic reactions developed in 6 patients; no allergic complaints were observed in 8 patients. After VIT was discontinued, 56 field sting reactions developed in 25 patients. Local allergic reactions developed in 9 patients, but no systemic allergic reactions were observed. Mastocytosis was diagnosed in a patient whose tryptase level was 42.4 and whose c-kit mutation was positive following haematological evaluation.
Conclusions: This study confirms that the prevalence of venom-induced anaphylaxis was calculated to be 0.058%. Being stung in the head and neck region was identified as a risk factor for the development of stage 3-4 (severe allergic reactions).
References
2 Worm M. Epidemiology of anaphylaxis. Chem Immunol Allergy. 2010;95:12-21. 10.1159/000315935. Epub 2010 Jun 1. PMid: 20519879.
3 Ring J, Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet. 1977; 1(8009):466–9. 10.1016/s0140-6736(77)91953-5
4 Ruëff F, Przybilla B, Biló MB, Müller U, Scheipl F, Aberer W, Birnbaum J, et al. Predictors of severe systemic anaphylactic reactions in patients with Hymenoptera venom allergy: importance of baseline serum tryptase-a study of the European Academy of Allergology and Clinical Immunology Interest Group on Insect Venom Hypersensitivity. J Allergy Clin Immunol. 2009;124(5):1047-54. 10.1016/j.jaci.2009.08.027
5 Claudia F, Ulrich M, Regina T, Wieland K, Freerk P. Long-term follow-up of children after venom ımmunotherapy: low adherence to anaphylaxis guidelines. Int Arch Allergy Immunol. 2017;172 (3):167–72. 10.1159/000458707
6 Saretta F, Giovannini M, Pessina B, Barni S, Liccioli G, Sarti L, et al. Venom immunotherapy protocols in the pediatric population: how to choose? Front Pediatr. 2023;11:1192081. 10.3389/fped.2023.1192081
7 Müller U, Golden DB, Lockey RF, Shin B. Immunotherapy for hymenoptera venom hypersensitivity. Clin Allergy Immunol. 2008;21:377–92.
8 Gonzalez Guzman LA, García Robaina JC, Barrios Recio J, Escudero Arias E, Liñares Mata T, Cervera Aznar R, et al. Real-world safety and efficacy clinical data of an ımproved allergen-specific ımmunotherapy product for the treatment of bee venom allergy. Vaccines (Basel). 2023;11(5):979. 10.3390/vaccines11050979
9 Glaeser A, Müller C, Bode S. Anaphylactic reactions in the build-up phase of rush immunotherapy for bee venom allergy in pediatric patients: a single-center experience. Clin Mol Allergy. 2022;20(1):4. 10.1186/s12948-022-00170-3
10 Golden DB, Demain J, Freeman T, Graft D, Tankersley M, Tracy J, et al. Stinging insect hypersensitivity: A practice parameter update 2016. Ann Allergy Asthma Immunol. 2017;118(1):28–54. 10.1016/j.anai.2016.10.031
11 Stritzke AI, Eng PA. Age-dependent sting recurrence and outcome in immunotherapy-treated children with anaphylaxis to Hymenoptera venom. Clin Exp Allergy. 2013;43(8):950–5. 10.1111/cea.12144
12 Pfützner W. Allergen immunotherapy of insect venom allergy: Almost 100 years old, but steadily updated. Allergol Select. 2023;7:211–218. 10.5414/ALX02420E
13 Ruëff F, Bauer A, Becker S, Brehler R, Brockow K, Chaker AM, et al. Diagnosis and treatment of Hymenoptera venom allergy: S2k Guideline of the German Society of Allergology and Clinical Immunology (DGAKI) in collaboration with the Arbeitsgemeinschaft für Berufs-und Umweltdermatologie e.V. (ABD), the Medical Association of German Allergologists (AeDA), the German Society of Dermatology (DDG), the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNOKC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Allergy and Environmental Medicine (GPA), German Respiratory Society (DGP), and the Austrian Society for Allergy and Immunology (ÖGAI). Allergol Select. 2023;7:154–90. 10.5414/ALX02430E
14 Cerniauskas K, Rudyte J, Linauskiene K, Chomiciene A, Griguola L, Malinauskiene L. Diagnosis and treatment of Hymenoptera venom allergy in adults: A single-center experience in Lithuania. World Allergy Organ J. 2024;17(3):100884. 10.1016/j.waojou.2024.100884
15 Golden DBK. Rush venom ımmunotherapy: ready for prime time? J Allergy Clin Immunol Pract. 2017;5(3):804–5. 10.1016/j.jaip.2016.12.031
16 Brehler R, Wolf H, Kütting 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(6 Pt 1):1231–5. 10.1067/mai.2000.105708
17 Stock R, Fischer T, Aẞmus K, Zoeller N, Ackermann H, Kaufmann R, Meissner M, Valesky E. Safety and tolerability of venom immunotherapy: Evaluation of 581 rush-and ultra-rush induction protocols (safety of rush and ultra-rush venom immunotherapy). World Allergy Organ J. 2020;14(1):100496. 10.1016/j.waojou.2020.100496
18 Cosme J, Spínola-Santos A, Pereira-Santos MC, Pereira-Barbosa M. Venom Immunotherapy: a 20-year experience with an ultra-rush protocol (210-min). Eur Ann Allergy Clin Immunol. 2019;51(3):122–8. 10.23822/EurAnnACI.1764-1489.85
19 Parke L, Fomsgaard Kjaer H, Sivertsen Garvik O, Halken S, Broesby-Olsen S, Bindslev-Jensen C, Mortz CG. Real-Life Adherence to Venom Immunotherapy and Adrenaline Autoinjector. Int Arch Allergy Immunol. 2024;185(3):228–36. 10.1159/000535294
20 Kołaczek A, Skorupa D, Antczak-Marczak M, Kuna P, Kupczyk M. Safety and efficacy of venom immunotherapy: a real life study. Postepy Dermatol Alergol. 2017;34(2):159–67. 10.5114/ada.2017.67082
21 Sözener ZÇ, Kendirlinan R, Çerçi P, Ayd N Ö, Mungan D, Bavbek S, Demirel Y, Mısırl Gil Z, Sin BA. Field sting reactions in patients receiving Hymenoptera venom immunotherapy: real-life experience. Asian Pac J Allergy Immunol. 2023;41(3):186–92. 10.12932/AP-011221-1282
22 Kayikci H, Bostan OC, Tuncay G, Cihanbeylerden M, Damadoglu E, Karakaya G, Kalyoncu AF. Efficacy and safety of hymenoptera venom immunotherapy. Allergy Asthma Proc. 2024;45(4):268–75. 10.2500/aap.2024.45.240035
23 Arzt L, Bokanovic D, Schwarz I, Schrautzer C, Massone C, Horn M, et al. Hymenoptera stings in the head region induce impressive, but not severe sting reactions. Allergy. 2016;71(11):1632–4. 10.1111/all.12967
24 O’Connell MP, Lyons JJ. Hymenoptera venom-induced anaphylaxis and hereditary alpha-tryptasemia. Curr Opin Allergy Clin Immunol. 2020;20(5):431–7. 10.1097/ACI.0000000000000678
25 Francuzik W, Ruëff F, Bauer A, Bilò MB, Cardona V, Christoff G, et al. Phenotype and risk factors of venom-induced anaphylaxis: A case-control study of the European Anaphylaxis Registry. J Allergy Clin Immunol. 2021;147(2):653–62.e9. 10.1016/j.jaci.2020.06.008
26 Kačar M, Rijavec M, Šelb J, Korošec P. Clonal mast cell disorders and hereditary α-tryptasemia as risk factors for anaphylaxis. Clin Exp Allergy. 2023;53(4):392–404. 10.1111/cea.14264
