A simple 3-day "rush" venom immunotherapy protocol: documentation of safety

ABSTRACT

Background: Venom immunotherapy (VIT) is the only effective treatment for hymenoptera hypersensitivity, but conventional protocols require a few weeks. Objective: We present the safety of a 3-day "rush" protocol that requires only 7 injections and 255mgr cumulative dose before the 100 µg maintenance dose. Methods: Forty-nine patients (33 males, 16 females) of mean age 43.57 ± 12.9yrs received "rush" VIT. Only 7 injections were required until the maintenance dose of 100mgr was reached on Day 5. On Day 1, four injections were administered with initial dose of 5mgr and total dose of 75 µg. On Day 3 a cumulative dose of 180mgr was administered in three injections (40mgr, 60mgr and 80mgr). A dose of 100mgr was administered on Day 5. Twenty-nine individuals were treated with Honey-Bee venom; 18 with Common wasp; 5 with Paper Wasp; while 13 patients received Mixed Vespid preparation. Inclusion criteria were documented IgE-mediated allergy with intradermal sensitivity to ≤0.1mgr/ml venom concentration and concomitant detection of specific venom IgE ≥ 35kU/l. Results: All patients reached the maintenance dose. Forty-nine patients received 65 immunotherapy courses, resulting in 1520 injections. Thirty-three systemic reactions 7 during building phase (1.5%); and 26 in the maintenance dose (2.4%) were observed in 9 patients. The percentage of reactions/total injection number was 2.2%; all reactions were mild-to-moderate. Fourteen patients reported documented field stings at least two months after VIT onset with only one reported mild systemic reaction. Conclusion: We propose a simple "rush" VIT protocol in an outpatient setting as an easy-to-perform alternative option for VIT induction phase