| Discontinuing venom immunotherapy. | |
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MedLine Citation:
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PMID: 11964712 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The decision to discontinue venom immunotherapy requires a great deal of clinical judgement because of the potential for a life-threatening reaction to a sting. The risk of recurrence is a combination of the frequency of reaction and the severity of reaction. Early studies reported a relapse rate of 8-14% in radioallergosorbent test-negative patients when therapy was stopped after 3 years. Unfortunately, the venom skin test or radioallergosorbent test becomes negative in only 25% of patients after 5 years of treatment. An alternative criterion for stopping treatment after 5 years regardless of the skin test has been equally successful, with most post-treatment reactions being much milder than pre-treatment reactions. There was no evidence of a rebound of venom sensitivity when therapy was stopped, even when patients were stung. The level of venom-specific IgE antibodies is better suppressed by 5 than by 3 years of treatment. The risk of relapse is higher in honeybee-allergic patients and in patients who had a systemic reaction (to a sting or an injection) during therapy. The frequency of reaction may be low, but patients who had very severe pre-treatment reactions have a greater chance of the reaction being severe again, and should remain on therapy for life. Long-term observations show that the incidence of systemic reaction to a sting remains 10% for each sting that occurs, even 10-15 years after stopping treatment. Because patients may not react to one sting and then subsequently react to another sting, the cumulative frequency of sting reactions is approximately 17% after 10 years off treatment. Moreover, negative venom skin tests are not a guarantee of safety because there is almost the same 10% frequency of reaction in patients who appear to lose sensitivity. It is not yet clear whether some low-risk patients (children, mild reactors) could discontinue treatment after just 3 years. |
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Authors:
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D B Golden |
Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, P.H.S.; Review |
Journal Detail:
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Title: Current opinion in allergy and clinical immunology Volume: 1 ISSN: 1528-4050 ISO Abbreviation: Curr Opin Allergy Clin Immunol Publication Date: 2001 Aug |
Date Detail:
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Created Date: 2002-04-19 Completed Date: 2002-06-13 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 100936359 Medline TA: Curr Opin Allergy Clin Immunol Country: United States |
Other Details:
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Languages: eng Pagination: 353-6 Citation Subset: IM |
Affiliation:
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Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland 21224, USA. GoldenMD@aol.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Animals Bee Venoms / immunology, therapeutic use* Child Desensitization, Immunologic / methods* Humans Hymenoptera / immunology* Hypersensitivity, Immediate / etiology, prevention & control* Insect Bites and Stings / immunology Treatment Outcome Wasp Venoms / immunology, therapeutic use* |
| Grant Support | |
ID/Acronym/Agency:
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AI08270/AI/NIAID NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Bee Venoms; 0/Wasp Venoms |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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