Impact of specific immunotherapy and sting challenge on the quality of life in patients with hymenoptera venom allergy

Abstract

Background An experienced life-threating anaphylactic reaction to hymenoptera venom can sustainably impair patients’ quality of life (QoL). Besides carrying emergency medication, venom-specific immunotherapy (VIT) exists as a causal treatment of allergy. Objective This study aimed to examine QoL, anxiety, depression, and physical and mental health in patients allergic to hymenoptera venom before and during VIT and the impact of a tolerated sting challenge (SC). Methods Between July 2017 and August 2017, 142 patients with venom allergy were analyzed using validated questionnaires as the: Vespid Allergy Quality for Life Questionnaire" (VQLQ-d), the "Hospital Anxiety and Depression Scale" (HADS-D) and the "Short Form 36" (SF-36). To evaluate the impact of VIT and SC on the QoL, patients were divided into 3 groups: (A) VIT and tolerated SC (n = 45), (B) VIT before carrying out SC (n = 73), and (C) therapy-naïve before VIT (n = 20). Further parameters like gender, age, insect species, and severity of the anaphylactic reaction were assessed. Results A significant correlation between the health-related QoL and the parameters of gender and state of treatment was seen. Especially male patients, as well as patients allergic to yellow jacket venom, benefit from a SC in terms of a significant increase in their QoL. In the total study cohort, a clear trend was observed towards a higher QoL in patients under VIT who tolerated a SC. Overall, neither the patients’ age nor the insect species exerted a relevant influence on QoL, depression or anxiety. However, women showed a lower QoL combined with higher anxiety and depression scores than men. Conclusion Immunotherapy leads to an improved QoL, which can be further increased by a SC. A tolerated SC conceivably reassures the patients by objectifying the treatment success. Female patients appear to have a stronger impaired QoL per se. Taken together, a SC can be performed during VIT to strengthen the patients’ QoL.

Health‐related quality of life in food and venom induced anaphylaxis and role of influencing factors

“…Irrespective of the general anxiety level, the time elapsed since the allergic reaction, reaction severity or age, women showed a stronger impairment in their HRQL than men 7 . Many studies confirmed this correlation of female sex and a stronger impairment on HRQL 62,71,72 . In a German study using sociodemographic and disease‐specific characteristics as well as the HADS, also female patients with mild SRs showed higher disease‐related anxiety levels than men 73 .…”

“…Sting challenges in patients receiving VIT are also associated with a significant improvement in HRQL, meaning that some patients trust their therapy only after the demonstration of its efficacy through a sting challenge 62,72,78 …”

Patient's Adherence and Compliance and Quality of Life During/After VIT

“…Such an outcome has been confirmed in a recent study, proving that the improved HRQL associated with VIT can be further increased by a tolerated sting challenge, that it is conceivable it can reassure the patients. A more marked effect was seen in the female gender (27). A fairly recent review has highlighted all aspects of Hymenoptera venom allergy and VIT, also considering adherence and quality of life, which were usually superior to those of other models of immunotherapy (28), although it remains to be clarified how much the results may vary according to the different centers that practice VIT (11).…”

The First Experience of Successful Immunotherapy (ASIT) in Patients with Allergy to Bee Venom in Belarus

“…В рутинной клинической практике предпочтительнее классификация, предложенная экспертами Европейской академии аллергии и клинической иммунологии (EAACI) [12] Для диагностики инсектной аллергии почти всегда достаточно изучения анамнеза. Обнаружение аллерген-специфических IgE-антител к аллергенам яда in vitro, которые обнаруживаются в 90% случаев, причем отмечается высокая корреляция между результатами кожных проб и лабораторного тестирования и/или положительные кожные тесты -скарификационный и prick-тест (предпочтительнее) с аллергеном яда насекомых, -позволяет верифицировать диагноз аллергии к яду насекомых [7,12,23]. При местных аллергических реакциях положительные кожные пробы регистрируются в 70-80% случаев, при системных в 90% случаев [18].…”

“…Единственным лечением, которое может потенциально предотвратить развитие системных реакций от ужаления насекомых, является АСИТ, т. е. повторное введение аллергена в повышающихся дозах через регулярные промежутки времени для модуляции иммунного ответа [7,9].…”