Safety of specific immunotherapy using an ultra-rush induction regimen in bee and wasp allergy

Bożek, Andrzej; Kołodziejczyk, Krzysztof

doi:10.1080/21645515.2017.1397245

Cited by 14 publications

(11 citation statements)

References 13 publications

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“…Of these, two thirds (n = 10) reached the cumulative dose of 101.1 μg in a further UR, 15 days later, with a premedication reinforcement and using the same UR protocol. In contrast to other studies published to date (16,17,21,22) our study has much more patients submitted honey bee VIT, and also 13 patients that underwent an UR protocol with paper wasp venom. These are particular aspects related to the environmental exposure to insects' stings in our country.…”

Section: Discussionmentioning

confidence: 86%

“…In these protocols the protective dose of 100 μg venom is reached in a quicker way, decreasing the potential risk of an anaphylactic sting reaction (1,8,14). Over the years, several studies have shown that this induction protocol is safe and effective (15,16,17,18). Nevertheless, there are still some concerns related to the occurrence of severe systemic reactions during the UR protocols.…”

Section: Introductionmentioning

confidence: 99%

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Allergic reactions after vaccination: translating guidelines into clinical practice

Cosme

Santos

Pereira-Santos

et al. 2019

Eur Ann Allergy Clin Immunol

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Background. Ultra-rush (UR) are induction protocols used in venom immunotherapy (VIT). Objectives. To evaluate the adverse reactions during a 210-minutes UR and determine possible risk factors. Methods. Retrospective study of 129 patients submitted to UR with VIT in the last 20 years. Results. In 114 (88.4%) patients, the 101.1 μg maintenance dose was reached in 210 minutes. Systemic reactions (SR) occurred in 22% of patients (71% mild). There were no severe SR, late reactions or fatalities. Adrenaline was administered in 10% of all UR. The SR were more frequent with honey bee VIT and had greater severity in the patients with a previous severe systemic sting reaction. No significant difference in the risk of SR was found with other demographic, clinical or laboratory factors. There were 5% of large local reactions (LLR), these being more frequent in females. Conclusion. Most SR during UR were mild with no need for adrenaline treatment. The honey bee venom and the severity of the anaphylaxis during the field sting were the only SR's risk factors for systemic adverse reactions during the UR. VIT is usually administered by subcutaneous injections with aqueous extracts and comprises an induction phase and a maintenance phase necessary to ensure a sustained effect over time (1). Since its development, several induction protocols have been proposed for VIT. These protocols differ from one another in the time required to reach the maintenance dose and in the interval between the injections (8,9,10). The risk of a new systemic sting reaction implies the need for the patient to reach the protection dose as quickly as possible. Thus, slow, conventional protocols with an induction period of 4 to 6 months and intervals between doses of 3 to 7 days have been progressively replaced by faster protocols (11,12). The latest include cluster or rush-modified protocols in which induction lasts generally 6 weeks (administration of 2 injections separated for 30 minutes every 3 to 7 days), rush protocols in which the induction lasts less than a week and the ultra-rush (UR) protocols in which the induction may last from 120 minutes to 2 days with doses being administered at intervals ranging from 20 minutes to 2 hours (11,12,13).

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Allergic reactions after vaccination: translating guidelines into clinical practice

Cosme

Santos

Pereira-Santos

et al. 2019

Eur Ann Allergy Clin Immunol

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“…Existing study data investigating whether certain treatment schedules are associated with a higher frequency of SR are highly conflicting [11,13,14,[22][23][24]. Large-scale studies ascribed accelerated protocols to a higher incidence of SR [13,14].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Safety Profiles of 3 Different Hymenoptera Venom Immunotherapy Protocols: A Retrospective 2-Center Study of 143 Patients

Pospischil

Kagerer

Cozzio

et al. 2020

Int Arch Allergy Immunol

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Introduction: Venom immunotherapy (VIT) is highly effective and the treatment of choice for patients with a history of systemic anaphylactic reactions to a Hymenoptera sting. It has been assumed that VIT protocols with a rapid dose increase during the induction phase are associated with a higher frequency of systemic reactions (SR); however, study data addressing this issue are conflicting. Objective: The aim of this study was to compare the safety of 3 different Hymenoptera VIT protocols (half-day ultra-rush, 3-day rush, 3-week cluster). Methods: This retrospective 2-center study included 143 Hymenoptera venom-allergic patients, who underwent 147 VIT procedures during the years 2015-2018. Twenty cluster, 75 rush, and 52 ultra-rush VIT protocols were performed with honeybee (54 protocols) and wasp (93 protocols) venom. All documented side effects were classified into large local and SR (Ring and Messmer classification). Results: SR were observed during 11 (7.5%) VIT procedures and did not exceed severity grade II. SR occurred more frequently in cluster compared to accelerated protocols. This result was observed for both honeybee (cluster: 25%, rush: 8.7%, and ultra-rush: 15.8%) and wasp VIT (cluster: 12.5%, rush: 0%, and ultra-rush: 6.1%), though the differences were statistically significant only in the wasp VIT subgroup. Honeybee venom elicited more SR than wasp venom (14.8 and 3.2%, respectively, p = 0.01). The risk for SR did not depend on age, sex, concomitant antihypertensive medication, hypertryptasemia, or severity of the index sting reaction. Conclusion: Accelerated VIT protocols, namely, rush and ultra-rush protocols are safe therapeutic options for Hymenoptera venomallergic patients and displayed fewer SR than cluster VIT protocols in our study.

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“…Additionally, it is well recognized that allergic reactions are a common adverse effect of rush DS. For example, a recent study evaluating desensitization regimens for bee and wasp venom reported that allergic reactions occurred in 13.7% of patients on an ultra‐rush regimen, 14.3% of patients on a rush regimen, and 26.5% of patients on a conventional immunotherapy regimen . This suggests that mast cell and basophil activation likely occur to some level in many patients undergoing desensitization.…”

Section: Discussionmentioning

confidence: 99%

Rush desensitization with a single antigen induces subclinical activation of mast cells and protects against bystander challenge in dually sensitized mice

Killoran

Kropp

Lindrose

et al. 2019

Clin Experimental Allergy

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Background: Rush desensitization can provide short-term tolerance to individuals who are allergic to certain medications in instances where other therapeutic interventions are limited. While rush desensitization (DS) is typically successful in preventing adverse type I hypersensitivity reactions, the mechanism of allergic protection remains unknown. Given the rise in prevalence of individuals displaying multiple allergies, understanding the impact of rush DS on "bystander" allergens, or additional allergens to which an individual is sensitized, could help inform clinical recommendations.Objective: To evaluate the effect of rush DS on bystander sensitization. Materials and Methods:We used a murine model of rush DS, whereby BALB/c mice were sensitized to ovalbumin (OVA) and desensitized through repeated intraperitoneal injections of OVA. Using a local anaphylaxis assay, we measured ear swelling by Evans blue extravasation following intradermal challenge. In studies to measure the impact on bystander antigens, a modified protocol was used in which mice were dually sensitized to OVA and Keyhole limpet hemocyanin (KLH), and densensitized to either OVA or KLH prior to allergic challenge.Results: The immunological effects of rush DS were independent of changes in Th1 and Th2 cytokine production and circulating OVA-IgE levels. Instead, rush DS resulted in subclinical degranulation of mast cells prior to challenge. In our dual sensitization model, rush DS with a single antigen conferred protection against allergic challenge to a secondary antigen. Bystander protection required prior sensitization, as DS with an irrelevant antigen did not impact allergic responsiveness. Conclusions and Clinical Relevance:We reveal that a key mechanism of rush DS protection against allergic responsiveness may be the subclinical degranulation of mast cells. Therefore, performing rush DS to a single antigen to which one is IgEsensitized may be sufficient to desensitize to multiple allergens. Future studies could lead to streamlined protocols of rush DS for patients with multiple allergies.

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Safety of specific immunotherapy using an ultra-rush induction regimen in bee and wasp allergy

Abstract: We found that the ultra-rush protocol (similar to the rush protocol) using the Venomenhal vaccine is safer than the conventional protocol.

Cited by 14 publications

References 13 publications

Allergic reactions after vaccination: translating guidelines into clinical practice

Allergic reactions after vaccination: translating guidelines into clinical practice

Comparison of the Safety Profiles of 3 Different Hymenoptera Venom Immunotherapy Protocols: A Retrospective 2-Center Study of 143 Patients

Rush desensitization with a single antigen induces subclinical activation of mast cells and protects against bystander challenge in dually sensitized mice

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