Insect Venom Immunotherapy: Analysis of the Safety and Tolerance of 3 Buildup Protocols Frequently Used in Spain.

INTRODUCTION: Hymenoptera venom immunotherapy (VIT) is an effective treatment but not one devoid of risk, as both local and systemic adverse reactions may occur, especially in the initial phases. We compared the tolerance to 3 VIT buildup protocols and analyzed risk factors associated with adverse reactions during this phase. MATERIALS AND METHODS: We enrolled 165 patients divided into 3 groups based on the buildup protocol used (3, 4, and 9 weeks). The severity of systemic reactions was evaluated according to the World Allergy Organization model. Results were analyzed using exploratory descriptive statistics, and variables were compared using analysis of variance. RESULTS: Adverse reactions were recorded in 53 patients (32%) (43 local and 10 systemic). Local reactions were immediate in 27 patients (63%) and delayed in 16 (37%). The severity of the local reaction was slight/moderate in 15 patients and severe in 13. Systemic reactions were grade 1-2. No significant association was found between the treatment modality and the onset of local or systemic adverse reactions or the type of local reaction. We only found a statistically significant association between severity of the local reaction and female gender. As for the risk factors associated with systemic reactions during the buildup phase, we found no significant differences in values depending on the protocol used or the insect responsible. CONCLUSIONS: The buildup protocols compared proved to be safe and did not differ significantly from one another. In the population studied, patients undergoing the 9-week schedule presented no systemic reactions. Therefore, this protocol can be considered the safest approach.

Insect venom immunotherapy: analysis of the safety and tolerance of 3 buildup protocols frequently used in Spain

Introduction: Hymenoptera venom immunotherapy (VIT) is an effective treatment but not one devoid of risk, as both local and systemic adverse reactions may occur, especially in the initial phases. We compared the tolerance to 3 VIT buildup protocols and analyzed risk factors associated with adverse reactions during this phase. Materials and Methods: We enrolled 165 patients divided into 3 groups based on the buildup protocol used (3, 4, and 9 weeks). The severity of systemic reactions was evaluated according to the World Allergy Organization model. Results were analyzed using exploratory descriptive statistics, and variables were compared using analysis of variance. Results: Adverse reactions were recorded in 53 patients (32%) (43 local and 10 systemic). Local reactions were immediate in 27 patients (63%) and delayed in 16 (37%). The severity of the local reaction was slight/moderate in 15 patients and severe in 13. Systemic reactions were grade 1-2. No significant association was found between the treatment modality and the onset of local or systemic adverse reactions or the type of local reaction. We only found a statistically significant association between severity of the local reaction and female gender. As for the risk factors associated with systemic reactions during the buildup phase, we found no significant differences in values depending on the protocol used or the insect responsible. Conclusions: The buildup protocols compared proved to be safe and did not differ significantly from one another. In the population studied, patients undergoing the 9-week schedule presented no systemic reactions. Therefore, this protocol can be considered the safest approach (AU)

Introducción: La inmunoterapia con veneno de himenópteros (ITV) es un tratamiento eficaz, pero no está desprovisto de riesgo ya que pueden ocurrir reacciones adversas locales o sistémicas, especialmente en las etapas iniciales del tratamiento. Comparamos la tolerancia de tres protocolos de inicio de ITV y analizamos los factores de riesgo asociados con las reacciones adversas que se produjeron en esta fase. Métodos: Se incluyeron 165 pacientes divididos en tres grupos según el protocolo de iniciación utilizado (3, 4 o 9 semanas). Evaluamos la gravedad de las reacciones sistémicas de acuerdo con el modelo de la Organización Mundial de Alergia. Analizamos los resultados mediante estadística descriptiva exploratoria y comparamos variables mediante el análisis de la varianza. Resultados: Cincuenta y tres pacientes (32%) experimentaron algún tipo de reacción adversa; 43 eran locales y 10 sistémicas. Las reacciones locales fueron inmediatas en 27 pacientes (63%) y tardías en 16 (37%). La gravedad de la reacción local fue leve o moderada en 15 pacientes y grave en 13. Las reacciones sistémicas fueron de grado 1 o 2. No encontramos asociación significativa entre la modalidad de tratamiento y la aparición de reacciones adversas locales o sistémicas o el tipo de reacción local. Solo encontramos una asociación estadísticamente significativa de la gravedad de la reacción local con el sexo femenino. En cuanto a los factores de riesgo asociados con las reacciones sistémicas en la fase de inicio, no se encontraron diferencias significativas en estos valores en función del protocolo utilizado o el insecto responsable. Conclusiones: Los protocolos de inicio comparados demostraron ser seguros y no difirieron significativamente entre sí. En la población estudiada, el protocolo de 9-semanas no produjo reacciones sistémicas, por lo que se puede considerar el protocolo más seguro (AU)

Estudio preliminar de desplazamiento del alergólogo a centros de atención primaria / Preliminary study of allergologic movement to primary care centres

Antecedentes: Actualmente los especialistas en alergología realizan la asistencia a nivel hospitalario. Entre los diferentes modelos de asistencia propuestos, en este estudio se aplica la incorporación parcial del alergólogo a centros de asistencia primaria. Objetivos: Reducir el tiempo de espera en la primera visita al servicio de alergia. Cuantificar el número de solicitudes y tipo de trastornos derivados para el estudio. Evaluar el grado de resolución del plan y satisfacción de los enfermos. Material y Métodos: El estudio se ha realizado desde septiembre de 2004 hasta mayo de 2005. El alergólogo se ha desplazad a un área Básica de Manresa (ABS-M3) para realizar la primera visita, exploraciones complementarias y una encuesta sobre el grado de satisfacción de los usuarios. Resultados: Se realizaron 112 primeras visitas con un tiempo máximo de espera de 30 días. La enfermedad respiratoria fue el motivo de consulta más frecuente (79/112, 70.5%) seguida de los síntomas cutáneos (urticaria, angioedema) 36/112 (32,1%), la alergia alimentaria 24/112 (21,4%), el estudio de alergia a fármacos 18/112 (16,1%), la dermatitis de contacto 2/112 (1,8%) y las enfermedades laborales 1/112 (0,9%). El 24,1% (27/112) de los pacientes fue dado de alta desde primaria sin necesidad de desplazarse al hospital mientras que el 75,9% (85/112) se derivó al hospital para completar el estudio o el seguimiento clínico. El absentismo fue inferior al hospitalario (3,4%). Conclusiones: El desplazamiento del alergólogo a centros de asistencia primaria reduce la espera para la consulta especializada. La enfermedad más frecuentemente derivada fue la respiratoria. El absentismo fue inferior al hospitalario y el grado de satisfacción de los pacientes elevado

Background: Currently allergologists make their general practice at hospital. The incorporation of allergologists to a primary health care centre is the model that has been applied in this pilot programme. Objectives: To reduce the delay for the first visit to the allergy department. To quantify the number of patients and type of pathology derived to study. To determine the level of satisfaction of patients achieved with this programme. Method: This study has been carried out from September 2004 to July 2005. An allergologist had moved to one of Manresa Primary Health Care Centers (ABS-M3) to perform the first visit, prick tests, measurement of lung function and a survey about the level of satisfaction of users. Results: We evaluated 112 patients with a maximum delay for each patient of 30 days. Respiratory symptom were the most common pathology remitted to study (79/112, 70.5%) followed by urticaria/angioedema (36/112, 32.1%), food allergy (24/112 21.4%), drug allergy 18/112 (16.1%), contact dermatitis 2/112 (1,8%) and occupational disease 1/112 (0.9%). Only 75.9% (85/112) had to be visited at hospital complete the study. The absenteeism level lowered in 3,4% compared with the patients visited in the hospital. Conclusions: The transfer of allergologists to primary health care centres reduces the time to the first specialized visit. Respiratory symptoms were the most common pathology derived to study. Absenteeism was lower than visit in hospital and users reported a high satisfaction level. Probably, a mixed model including hospitals and primary health care centres would be a good model to improve medical assistance in allergy