Three Days Rush Venom Immunotherapy in Bee Allergy: Safe, Inexpensive and Instantaneously Effective

Abstract

Background: Rush venom immunotherapy (VIT) is highly effective in vespid venom allergy, but comparable data regarding bee venom (BV) allergy are sparse. We evaluated its safety, efficacy and cost in BV-allergic patients. Methods: Conventional or rush VIT were offered to all patients with systemic reaction to insect sting. Rush VIT was also given to hyperreactive patients who failed to reach the maintenance dose with conventional VIT due to multiple systemic reactions. In BV-allergic patients, honeybee sting challenge was performed within 1 week after reaching the maintenance dose. Results: 179 patients, some of them allergic to more than one venom, received 246 rush VIT courses. Bee VIT was administered to 132 patients (73.7%); 173 patients (96.6%) reached the maintenance dose. The incidence of systemic reactions was 29.6%. They were more common in VIT with BV than with vespid venoms (31.1 and 16.3%, respectively, p = 0.01). After excluding the hyperreactive subgroup (n = 20), this difference was not significant (23.7 and 16%, respectively, p = 0.19). Despite the high incidence of systemic reactions (15 of 20, 75%) among hyperreactive patients, 17 patients (85%) achieved the maintenance dose. Sting challenges resulted in systemic reaction in 4 of 8 (50%) hyperreactive patients and in 2 of 47 (4.3%) ordinary patients. The cost of rush VIT was 41% of that of conventional VIT. Conclusions: Rush VIT with BV is safe, instantaneously effective, less expensive and enables most patients with previous failures of conventional VIT to reach the maintenance dose.

Venom Immunotherapy in High-Risk Patients: The Advantage of the Rush Build-Up Protocol

“…Others found that RVIT was as safe as CVIT, especially in vespid venom allergy [22]. We have demonstrated in the past the safety and efficiency of our rush build-up protocol in the general population as well as in children, including very young children, when most of the patients were allergic to BV [8,23]. Thus, in accordance with our previous findings, the current study also found a lower incidence of SR per injection in patients receiving RVIT compared to CVIT despite the fact that all of the patients with a high baseline tryptase level, which is known to be a major risk factor for VIT- ISR, were in the RVIT group.…”

“…This rate was significantly higher in the RVIT group compared to the CVIT group (35 [100%] and 24 patients [82.7%], respectively; p = 0.01). We were not able to reach the full maintenance dose in 5 patients of the CVIT group due to recurrent SR. As previously described [8,9], all of the patients who failed to reach the maintenance dose by CVIT were offered RVIT. Four patients who consented underwent a recurrent build-up phase with RVIT and reached the 100-μg maintenance dose uneventfully.…”

“…The detailed protocols of both methods have been published elsewhere [8]. Briefly, in the absence of SR to the treatment, the build-up phase lasts 3 days with RVIT and includes 14 injections.…”

“…Some BV allergic patients underwent a live bee sting challenge 1 week after reaching the maintenance dose as part of a previous study [8]. …”

Safety of Modified Ultra-Rush Venom Immunotherapy in Children

“…Various dose titration protocols have been suggested for the initiation of VIT [9,10]. The aim is to achieve rapid protection, especially during the flight time of the insects [11].…”