Honeybee venom immunotherapy in children using a 50-μg maintenance dose

Houliston, Louise; Nolan, Richard; Noble, Valarie; Pascoe, Elaine M.; Hobday, John D.; Loh, Richard; Mallon, Dominic

doi:10.1016/j.jaci.2010.07.031

Cited by 34 publications

(11 citation statements)

References 9 publications

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“…The authors of two recent studies demonstrate a reasonable efficacy of 50 µg maintenance doses in children and therefore advocate the use of reduced doses in order to improve the safety while decreasing the costs of treatment [12, 13]. Given the good tolerability of 100 µg doses in children and the clear dose-dependency of VIT [31], we and others opt for the use of standard dose increase protocols with a target dose of 100 µg in pediatric patients [15, 16, 18].…”

Section: Discussionmentioning

confidence: 99%

Safety of 100 µg venom immunotherapy rush protocols in children compared to adults

Stoevesandt

Hosp

Kerstan

et al. 2017

Allergy Asthma Clin Immunol

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BackgroundThere is a paucity of studies examining the safety of venom immunotherapy (VIT) in children. We aimed to assess the incidence of anaphylactic side effects during rush VIT in a cohort of pediatric patients and adult controls.Methods72 consecutive cycles of VIT-buildup in 71 children/adolescents aged 7–17 years were retrospectively evaluated and compared to an adult control group (n = 981) with regard to baseline parameters (sex, causative venom, severity of index sting reaction, results of allergy testing, comorbidities) and the incidence of anaphylactic adverse reactions.ResultsCompared to adults, severe index sting-induced anaphylaxis was significantly less common in children (P = .001). Children were more likely to suffer from bee venom allergy (P < .001) and showed higher levels of bee venom-specific IgE (P = .013), but lower serum tryptase concentrations (P = .014). The overall rate of VIT-induced anaphylactic reactions was higher in children than in adults (6.9% vs 2.5%, P = .046 by univariate analysis). In the final binary logistic regression model, however, only bee VIT (P = .039; odds ratio 2.25; confidence interval 1.04–4.87) and 5-day compared to 3-day buildup protocols (P = .011; odds ratio 2.64; confidence interval 1.25–5.57) were associated with an increased risk of treatment-induced anaphylaxis. All pediatric patients finally reached and tolerated the target maintenance dose of 100 µg.ConclusionsThe higher anaphylactic reaction rate observed in pediatric patients may be attributed to a greater prevalence of bee venom allergy. VIT-induced anaphylaxis in children is usually mild and does not affect further updosing and maintenance of VIT.

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Section: Discussionmentioning

confidence: 99%

Safety of 100 µg venom immunotherapy rush protocols in children compared to adults

Stoevesandt

Hosp

Kerstan

et al. 2017

Allergy Asthma Clin Immunol

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“…Only a minority of cross-reactive carbohydrate2negative patients who were double positive for both insect venom major allergens (8/23 [24%]) had a genuine sensitization to both, whereas 66% were sensitized to only 1 venom. Regarding therapeutics, Houliston et al 71 found that a 50-mg maintenance dose of honeybee venom in children was similarly effective to a 100-mg dose.…”

Section: Hypersensitivity To Stinging Insectsmentioning

confidence: 99%

Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2011

Sicherer

Leung

2012

Journal of Allergy and Clinical Immunology

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This review highlights some of the research advances in anaphylaxis; hypersensitivity reactions to foods, drugs, and insects; and allergic skin diseases that were reported in the Journal in 2011. Food allergy appears to be increasing in prevalence and carries a strong economic burden. Risk factors can include dietary ones, such as deficiency of vitamin D and timing of complementary foods, and genetic factors, such as filaggrin loss-of-function mutations. Novel mechanisms underlying food allergy include the role of invariant natural killer T cells and influences of dietary components, such as isoflavones. Among numerous preclinical and clinical treatment studies, promising observations include the efficacy of sublingual and oral immunotherapy, a Chinese herbal remedy showing promising in vitro results, the potential immunotherapeutic effects of having children ingest foods with baked-in milk if they tolerate it, and the use of anti-IgE with or without concomitant immunotherapy. Studies of allergic skin diseases, anaphylaxis, and hypersensitivity to drugs and insect venom are elucidating cellular mechanisms, improved diagnostics, and potential targets for future treatment. The role of skin barrier abnormalities, as well as the modulatory effects of the innate and adaptive immune responses, are major areas of investigation.

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“…The recently reported article by Louise Houliston and colleagues in the latest number of Journal of Allergy and Clinical Immunology suggests to use a 50‐μg maintenance dose for honeybee venom immunotherapy (VIT) in children instead of the recommended dose of 100 μg (1): VIT has been shown to be an effective and safe treatment for preventing sting‐induced anaphylaxis in patients with systemic reactions to hymenoptera stings, but a remaining problem is the relative effectiveness and safety of different immunotherapy protocols used with respect to maintenance dose, injection interval, and duration. The suggestion to halve the recommended dose is justified because a smaller injection volume should be better tolerated with a lower cost of VIT; actually, this seems to be also the experience of other groups (2).…”

mentioning

confidence: 99%

“…Desensitization of basophils to specific allergens during the up‐dosing phase of injection immunotherapy may contribute to the clinical effect of immunotherapy (5) while both the allergen dose and the cell activation state can change dramatically the response of basophil to VIT, leading to a bimodal behavior (6). While it is worth of consideration the suggestion to use a less concentrated maintenance dose, as addressed by some Authors (1, 2), it looks like rather frustrating that there are not significant differences with results published using 100 μg and that in adults the protection rate to challenge hymenoptera stings is about 79% in subjects who received 50 μg compared to a more reassuring 96% in those receiving 100 μg (1). Some Author has even criticized the opportunity of honeybee VIT in children (7).…”

mentioning

confidence: 99%

“…Evidence has reported that in basophils aqueous extracts of honey bee venom used for skin diagnosis and immunotherapy elicit a biphasic response following an IgE‐mediated activation (6): this evidence raises questions about the allergen dose and the response machinery of cells involved in hypersensitivity. Moreover, a dose range of honey bee venom higher than 10 μg/ml exhibits an activation of basal basophil function, what might explain the initial side‐effect reaction due to the injection of hymenoptera venom (1, 6). Skin tests and serum IgEs, besides to anamnesis, represent the commonest strategies to diagnose hymenoptera sting allergy and follow up therapy.…”

mentioning

confidence: 99%

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