Tolerability, course and follow-up of specific immunotherapy using a modified ultra-rush procedure in children and adolescents with insect venom allergy

Abstract

Summary Background Specific immunotherapy with insect venom (hymenoptera venom (HG)-AIT) is an effective and the only causal treatment for patients with systemic reactions due to IgE-mediated insect venom allergy. The present study investigated the quality of care after bee and wasp venom allergy, the tolerability of modified ultra-rush immunotherapy and the course after the conclusion of maintenance therapy in children and adolescents. Studies on the quality of life of children with insect venom allergy are scarce. Methods The efficacy, safety and tolerability of an ultra-rush protocol was analysed in 114 patients aged 4–17 years with insect venom allergy. After the end of HG-AIT, patients were contacted by questionnaire and asked to report on the quality of care as well as the course of insect venom allergy, including accidental stinging events. Quality of life was validated using the established questionnaire VQLQ‑d (Vespid Quality of Life Questionnaire), which is also used for bee venom allergy patients. Results Discontinuation of the initial therapy was not necessary in any patient. Side effects were mostly mild and did not require treatment. In 16 patients, a new sting reaction occurred during maintenance therapy, in another 15 patients a sting event was documented after cessation of HG-AIT. The intensity of the reaction to the accidental insect bite according to the severity classification after Ring and Messmer decreased from an average of 2.3 to 0.9 in these patients. This corresponds to a decrease of 61%. An emergency kit was carried by 70% of the patients, the expiry date of which, however, had already passed in almost 40% of the respondents. After the end of the therapy, most patients were not under any medical care or had never been to a check-up (92%). The evaluation of the VQLQ‑d showed a medium to low level of stress during or after therapy. Discussion Ultra-rush AIT in childhood and adolescence is safe, tolerable and effective. HG-AIT has a lasting positive effect on the health-related quality of life of patients. However, after the end of HG-AIT, there are deficits in the follow-up and care of the patients.

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

“…As suggested during the development of the VQLQ and later shown in another study, the impact on HRQL differs between honeybee‐allergic beekeepers and non‐beekeepers but the impact on HRQL of honeybee‐allergic non‐beekeepers is comparable to the impact perceived by patients allergic to vespid venom 65,71 . Without distinguishing between the beekeeper‐status, some 70 but not all studies 69,72 observed a lower impairment of HRQL in bee‐venom allergic patients compared to those allergic to wasp venom.…”

“…With the use of CHVAQoLS in Polish children, a higher anxiety in girls within the group of dermal reactors was shown, but higher levels of anxiety in boys than girls with grade II reactions were observed, 4 while other studies did not find any significant differences between girls and boys 69 . A significant association between the severity of the anaphylactic reaction (Mueller's grade IV compared to grade III) and anxiety was reported, 5 but not confirmed by others 69 .…”

“…Improvement of HRQL has been also observed in children, adolescents as well as their parents during VIT, mainly related to a lower level of anxiety 5,6,69 . The VIT protocol seems to have an effect on HRQL of treated patients, where patients treated with a conventional, longer lasting protocol showed a lower level of discomfort 5 .…”

“…2 Improvement of HRQL has been also observed in children, adolescents as well as their parents during VIT, mainly related to a lower level of anxiety. 5,6,69 The VIT protocol seems to have an effect on HRQL of treated patients, where patients treated with a conventional, longer lasting protocol showed a lower level of discomfort. 5 This may suggest a broader sense of burden of treatment and disease itself, and it might be necessary to improve the medical information on the advantages of shorter protocols.…”

“…68 In some studies, in adult and children the VQLQ was also used to measure HRQL of bee-venom allergic patients. 60,64,65,69,70 Beevenom allergic patients may face different problems than vespid venom allergic patients, as the risk of being stung differs between both patient groups. 59 In addition, many bee-venom allergic patients are beekeepers or family members of those.…”