Document Detail


Discontinuing venom immunotherapy.
MedLine Citation:
PMID:  11964712     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
D B Golden
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.; Review    
Journal Detail:
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:
Created Date:  2002-04-19     Completed Date:  2002-06-13     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  100936359     Medline TA:  Curr Opin Allergy Clin Immunol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  353-6     Citation Subset:  IM    
Affiliation:
Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland 21224, USA. GoldenMD@aol.com
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MeSH Terms
Descriptor/Qualifier:
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:
AI08270/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Bee Venoms; 0/Wasp Venoms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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