Reduction of side effects from rush‐immunotherapy with honey bee venom by pretreatment with terfenadine

Berchtold, E.; Maibach, R; Müller, Ulrich

doi:10.1111/j.1365-2222.1992.tb00115.x

Cited by 95 publications

(56 citation statements)

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“…Some studies indicated that pretreatment with antihistamine lead to a reduction in occurrence of systemic reactions following immunotherapy [52][53][54][55][56][57]. In contrast, other studies [58,59] observed no significant decrease of systemic reactions with the premedication use of antihistamines. It worth mentioning that antihistamine pretreatment does reduce systemic reactions without influencing the efficacy of immunotherapy [57].…”

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confidence: 94%

Systemic Adverse Reaction to Specific Immunotherapy

Alsamarai¹,

Alobaidi²,

Alwan³

et al. 2011

J Aller Ther

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Background: Allergen immunotherapy has been reported to be effective in reducing allergic symptoms and drug consumption in cases of respiratory allergy. However, some concerns still exist about the relative safety of allergen immunotherapy. This form of therapy has a potential risk of serious systemic reactions.Objective: To evaluate the frequency of systemic reactions due to subcutaneous allergen immunotherapy in Iraq and to identify factors associated with increased risk of adverse systemic reaction. Methods:From January 2000 to December 2008, we selected 693 patients with allergic rhinitis and asthma to receive subcutaneous specific immunotherapy. Prospective immunotherapy safety was evaluated by recording postinjection adverse effects. The adverse reaction observed during the administration of subcutaneous immunotherapy within a period of 9 years (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008), was analyzed in this study.Result: Data were obtained from 693 patients who received subcutaneous immunotherapy (SCIT). The mean number of skin tests positivity and number of injections were significantly higher in systemic reaction group compared to negative systemic reaction group. During the study period, a total of 39281 injections were administered to 693 patients. Of the 693 patients, 82 (11.8%) had systemic reaction, with an incidence of 2.1/1000 injection. Sixty nine of the 82 systemic reaction (84%) developed in the build up phase, versus 13 (16%) in the maintenance phase (p<0.0001), with respect to reaction time, 47 (57%) of the systemic reaction were immediate (within 30 minutes respect to reaction time), and 35 (43%) were delayed. There were higher significant influences of polysensitisation, age, asthma, combination of asthma and allergic rhinitis, type of allergen, and indoor allergens on the development of systemic adverse reactions to subcutaneous immunotherapy. Conclusion:The present study suggests that SCIT was a safe treatment with a low risk to elicit severe systemic reaction, in which no fatality was observed. Furthermore, this study indicated that mold, HDM, asthma, presence of asthma and allergic rhinitis (AR), polysensitisation, and indoor allergens sensitization were a risk factors contributing to systemic reactions. consents were obtained from all patients (or their parents for children) before the initiation of immunotherapy and the guidelines were followed to monitor patients during allergen extract injection. Systemic Adverse Reaction to Specific ImmunotherapyThe adverse reaction observed during the administration of subcutaneous immunotherapy within a period of 9 years (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008), was analyzed in this study. Demographic and clinical data and peak expiratory flow before and after injection were recorded by the investigators on a standardized form. Immunotherapy scheduleImmunotherapy was given in term of conventional schedule. Conventional Immunotherapy build-up was typically given as injection per week until the maintenance dose wa...

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confidence: 94%

Systemic Adverse Reaction to Specific Immunotherapy

Alsamarai¹,

Alobaidi²,

Alwan³

et al. 2011

J Aller Ther

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“…[65][66][67][68] In detail, it was reported that levocetirizine decreased the rate of SSR 68 and fexofenadine decreased the rate of LLR and cutaneous SSR 67 (Table 3). Importantly, effectiveness of VIT was not negatively influenced.…”

Section: Preventive Pretreatmentmentioning

confidence: 99%

EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

Sturm

Varga

Roberts

et al. 2017

Allergy

398

528

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Hymenoptera venom allergy is a potentially life‐threatening allergic reaction following a honeybee, vespid, or ant sting. Systemic‐allergic sting reactions have been reported in up to 7.5% of adults and up to 3.4% of children. They can be mild and restricted to the skin or moderate to severe with a risk of life‐threatening anaphylaxis. Patients should carry an emergency kit containing an adrenaline autoinjector, H1‐antihistamines, and corticosteroids depending on the severity of their previous sting reaction(s). The only treatment to prevent further systemic sting reactions is venom immunotherapy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Venom Immunotherapy as part of the EAACI Guidelines on Allergen Immunotherapy initiative. The guideline aims to provide evidence‐based recommendations for the use of venom immunotherapy, has been informed by a formal systematic review and meta‐analysis and produced using the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included representation from a range of stakeholders. Venom immunotherapy is indicated in venom‐allergic children and adults to prevent further moderate‐to‐severe systemic sting reactions. Venom immunotherapy is also recommended in adults with only generalized skin reactions as it results in significant improvements in quality of life compared to carrying an adrenaline autoinjector. This guideline aims to give practical advice on performing venom immunotherapy. Key sections cover general considerations before initiating venom immunotherapy, evidence‐based clinical recommendations, risk factors for adverse events and for relapse of systemic sting reaction, and a summary of gaps in the evidence.

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“…The H1-RA disadvantage in clinical effectiveness may be explained on the one hand by a slightly lower clinical potential of desloratadine and its predecessor loratadine in comparison to other newer antihistamines. On the other hand, previous reports dealing with premedication in SIT of which one employed loratadine [11] and the others other H1-RAs [7,8,9,10, 12, 13] were mostly designed to study the prevention of anaphylactic reactions as primary outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Although the risk-benefit ratios of conventional and rush SIT are excellent [6], side effects in these usually young and otherwise healthy patients have always been a matter of concern. Premedication with antihistamines (H1-RA) prior to each vaccination has been shown to significantly decrease the low rate of severe anaphylactic or other systemic side effects in SIT with venom as well as pollen allergens [7,8,9,10,11,12,13]. However, local reactions (LRs) are common in SIT and can reduce the patient’s compliance to this sometimes lifelong therapy [14,15,16].…”

Section: Introductionmentioning

confidence: 99%

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Premedication with Montelukast Reduces Local Reactions of Allergen Immunotherapy

Wöhrl¹,

Gamper²,

Hemmer

et al. 2007

Int Arch Allergy Immunol

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Background: Local reactions (LRs) are a very frequent side effect of specific immunotherapy with allergens and can impair patients’ adherence. Antihistamine pretreatment – originally introduced as a safety measure to reduce anaphylactic side effects – has been the only treatment option for LRs so far, although these swellings usually do not appear immediately but after hours. We were interested whether pretreatment with the leukotriene antagonist montelukast would be better suited for preventing those reactions than pretreatment with the antihistamine desloratadine. Methods: Fifteen patients with a history of severe anaphylactic reactions to hymenoptera stings were enrolled into a prospective, double-blind, randomized, placebo-controlled pilot study. We selected a rush immunotherapy protocol consisting of 19 injections of hymenoptera venom administered over 5 consecutive days, where the majority is developing LRs, and counted the number of injections until an LR of >3 cm occurred. The patients were randomized to 3 treatment groups: premedication with placebo, 10 mg montelukast and 5 mg of the antihistamine desloratadine. Results: Compared with placebo, the occurrence of LRs (>3 cm) was significantly delayed by montelukast (p < 0.01, analysis of variance) but not by desloratadine (p = 0.19). The difference between montelukast and desloratadine was close to significant (p = 0.054). Itching, recorded on a scale from 0 to 5, did not differ between the 3 groups. Conclusion: Montelukast can be useful in the prevention of LRs after specific immunotherapy.

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Reduction of side effects from rush‐immunotherapy with honey bee venom by pretreatment with terfenadine

Cited by 95 publications

References 11 publications

Systemic Adverse Reaction to Specific Immunotherapy

Systemic Adverse Reaction to Specific Immunotherapy

EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

Premedication with Montelukast Reduces Local Reactions of Allergen Immunotherapy

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