Safety and tolerability of venom immunotherapy: evaluation of 581 rush- and ultra-rush induction protocols (safety of rush and ultra-rush venom immunotherapy)

  • Background: Current literature is inconsistent regarding the risk of severe side effects using accelerated induction protocols in Hymenoptera venom immunotherapy (VIT). In addition, several data indicate the influence of purity grade of venom preparation on tolerability. We evaluated the safety and tolerability of ultra-rush and rush build-up protocols using purified and non-purified venom preparations. Methods: Retrospective single-center study of 581 VIT inductions (325 ultra-rush and 256 rush protocols) from 2005 to 2018 in 559 patients with bee and vespid venom allergy using aqueous purified (ALK SQ®) for ultra-rush protocol and aqueous non-purified (ALK Reless®) venom preparations for rush protocol. Results: Urticaria (8% vs. 3.1%, p = 0,013) and dose reductions (4.3% vs. 1.2%, p = 0,026) were significantly more frequent in the ultra-rush group. Overall rate of moderate-to-severe side effects (anaphylaxis ≥grade 2 according to Ring and Meβmer) was low and did not differ significantly between protocols (p = 0.105). Severe events (grade 4 anaphylaxis) were not reported. Discontinuation rate was very low in both cohorts (0.6% vs 1.2%). The higher purity grade of venom preparations in the ultra-rush cohort did not improve tolerability. The bee venom group showed a non-significant trend towards higher incidence of mild reactions (urticaria), resulting in more frequent dose reductions and antiallergic therapy. Conclusion: Rush and ultra-rush protocols show an excellent safety profile with only infrequent and mild anaphylactic reactions in bee and vespid venom allergy. Ultra-rush immunotherapy reduces the duration of the inpatient build-up phase setting and thus is viewed by the authors as preferred treatment in Hymenoptera venom allergic patients.

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Author:Reinhard StockGND, Tatjana Fischer, Katharina Aßmus, Nadja Nicole ZöllerORCiDGND, Hanns AckermannGND, Roland KaufmannGND, Markus MeissnerORCiDGND, Eva Maria ValeskyORCiDGND
Parent Title (English):World Allergy Organization Journal
Place of publication:Amsterdam
Document Type:Article
Date of Publication (online):2020/12/15
Date of first Publication:2020/12/15
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2021/08/17
Tag:Bee venom allergy; Hymenoptera venom immunotherapy; Rush protocol; Ultra-rush protocol; Vespid venom allergy
Issue:1, art. 100496
Article Number:100496
Page Number:13
First Page:1
Last Page:13
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0