Imported fire ant immunotherapy prescribing patterns in a large health care system during an 11-year period

Wauters, Robert H.; Brooks, Daniel I.; Schwartz, David J.

doi:10.1016/j.anai.2020.06.013

Cited by 11 publications

(11 citation statements)

References 10 publications

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“…There is ample evidence on the reliability of diagnostic procedures and the effectiveness of VIT and sufficient knowledge of adherence to VIT with Hymenoptera venom from vespids and bees, while some aspects have not yet been clarified. One concerns adherence to imported fire antimmunotherapy; despite further studies to be compared to the only one available have been requested ( 15 ), the available data are insufficient to reach the level of evidence. Regardless of the different responsible Hymenoptera, the possible correlation between the effectiveness of VIT and its adherence has not been investigated so far.…”

Section: Discussionmentioning

confidence: 99%

“…Immunotherapy was prescribed since the 1970s with wide variability of outcomes. A recent review surveyed the outcomes of immunotherapy over 15 years compared to a similar 2009 study, finding a significant improvement in the accuracy and precision of immunotherapy dosing, the predominant dose being.5 ml 1:100 wt/vol, i.e., higher than those previously used ( 15 ).…”

Section: Adherence To Venom Immunotherapymentioning

confidence: 99%

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

et al. 2022

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Adherence and compliance, respectively considered as a more positive, proactive behavior, resulting in a patient's lifestyle change to follow a daily regimen, and, as a more enforced response to an external command, are a critical aspect of any medical therapy, since it is estimated that less than half of the patients who are prescribed a therapy perform it, respecting the doses and duration. As far as aeroallergen immunotherapy is concerned, current data show that adherence is respected in about 50% of subcutaneous immunotherapy and in percentages even lower than 20% in sublingual immunotherapy treatments. This review analyzes the adherence to venom immunotherapy (VIT), in which, given its purpose of preventing potentially fatal anaphylactic reactions to insect stings, this aspect plays a critical role. In fact, protection from stings already takes place when the maintenance dose is reached, but VIT interruption before the recommended duration of 5 years exposes patients to new sting reactions. The data on adherence to VIT are far less abundant than that for aeroallergen immunotherapy. One of the first studies reported poor adherence in Austria, but the model used, consisting in the estimate of the percentage of patients with systemic reactions who accepted or rejected VIT, does not meet the criteria that define adherence to treatment. As for appropriate adherence studies, rates higher than 70% were reported in the United States and European countries. Studies from Italy found that good adherence were observed also in patients receiving, after 4 years of VIT, 3 months extended maintenance dose, as well as in patients treated during the COVID-19 pandemic, <10% of whom stopped VIT. Instead, only 35% of the patients treated for allergy to imported fire ant remained adherent after 1 year of treatment. However, also concerning honeybees and vespids, although adherence is satisfactory, it is possible to further improve it by increasing information and support for patients. Health-related quality of life (HRQL) is an efficient measure to estimate the effectiveness and safety of medical treatment. Tools designed to make patients aware of its improvement through VIT and, in particular, of the complete prevention of the risk of fatal reactions have an important role in reinforcing adherence. However, aspects not yet evaluated, such as the possible relationship between the efficacy of VIT and HRQL or its particular features in patients with mastocytosis, deserve specific studies.

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Section: Discussionmentioning

confidence: 99%

Section: Adherence To Venom Immunotherapymentioning

confidence: 99%

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

et al. 2022

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“…Effective VIT against S. invicta was first demonstrated by case series using whole body extract in 1992with 98% success at preventing anaphylaxis on subsequent reported stings. 75,76 Purified M. pilosula VIT proved 100% effective at preventing anaphylaxis in a double sting-challenge during a double-blind randomised-controlled trial. 77 Although highly effective, it is frequently associated with systemic adverse events depending on the up-dosing protocol.…”

Section: Formicidaementioning

confidence: 99%

Allergy to stings and bites from rare or locally important arthropods: worldwide distribution, available diagnostics, and treatment

Arzt‐Gradwohl

Sturm

Boni

et al. 2023

Preprint

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Insect venom allergy is the most frequent cause of anaphylaxis in Europe and possibly worldwide. The majority of systemic allergic reactions after insect stings are caused by Hymenoptera and among these, vespid genera induce most of the systemic sting reactions (SSR). Honey bees are the second leading cause of SSR. Depending on the global region, other Hymenoptera such as different ant genera are responsible for SSR. Widely distributed hornets and bumblebees or local vespid or bee genera rarely induce SSR. Hematophagous insects such as mosquitoes and horse flies usually cause (large) local reactions while SSR occasionally occur. This position paper aims to identify either rare or locally important insects causing SSR as well as rarely occurring SSR after stings or bites of widely distributed insects. We summarized relevant venom or saliva allergens and intended to identify possible cross-reactivities between the insect allergens. Moreover, we aimed to locate diagnostic tests for research and routine diagnosis, which are sometimes only regionally available. Finally, we gathered information on disposable immunotherapies. Major allergens of most insects were identified, and cross-reactivity between insects was frequently observed. While some diagnostics and immunotherapies are locally available, standardized skin tests and immunotherapies are generally lacking in rare insect allergy.

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“…Brown et al 21 reported that venom immunotherapy with M pilosula (jack jumper) was very effective in preventing life-threatening sting anaphylaxis, and it could bene t the population in areas of southeastern Australia where Myrmecia ant stings occur. La Shell et al 23 showed that three-year subcutaneous immunotherapy with whole-body extract is safe; however, speci c IgE and IgG4 antibodies or tryptase before and after immunotherapy were not evaluated.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Laboratory Profile of Patients with Anaphylaxis To Fire Ant Venom (Solenopsis sp.) Under Subcutaneous Immunotherapy

Watanabe

Ferreira

Ventura

et al. 2022

SN Compr. Clin. Med.

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Anaphylaxis to re ant venoms (Solenopsis sp) is a signi cant cause of systemic allergic reaction caused by Hymenoptera stings in children. There are only a few reports about the safety and e cacy of speci c immunotherapy. We aim evaluate clinical characteristics, IgE and IgG4 speci c responses of patients undergoing immunotherapy with a whole-body extract of Solenopsis sp after one year of the maintenance phase. Thirty-three patients were enrolled due to anaphylaxis by re ant venom (Solenopsis sp) and underwent speci c venom immunotherapy. They were assessed at baseline and one year after the beginning of the maintenance phase for skin test; speci c IgE and IgG4 antibodies to re ant venom; tryptase. All patients included presented a severe anaphylactic reaction. Although two patients (6.25%) presented a tryptase level higher than 11.4 ug/ml, systemic mastocytosis was ruled out. There was no relationship between the severity of the reaction with gender, tryptase level, atopy, previous reactions, concentration of the allergen in the skin test or speci c IgE level. There was an increase of the speci c IgG4/IgE ratio between the two time points. Reactions were local, with only two mild systemic reactions during the build-up phase. Twenty patients had accidental stings during immunotherapy, with 3 presenting only urticaria. This study is unprecedented in evaluating clinical and laboratory data in the re ant immunotherapy. Our results show that after one year of the maintenance phase, patients did not develop any severe reaction with only a few mild reactions and presented a signi cant production of speci c IgG4.

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Imported fire ant immunotherapy prescribing patterns in a large health care system during an 11-year period

Cited by 11 publications

References 10 publications

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

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

Allergy to stings and bites from rare or locally important arthropods: worldwide distribution, available diagnostics, and treatment

Clinical and Laboratory Profile of Patients with Anaphylaxis To Fire Ant Venom (Solenopsis sp.) Under Subcutaneous Immunotherapy

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