Return to content in this issue

 

Factors Affecting the Safety and Effectiveness of Venom Immunotherapy

Arzt-Gradwohl L1, Herzog SA2, Aberer W1, Alfaya Arias T3, Antolín-Amérigo D4,5, Bonadonna P6, Boni E7, Bożek A8, Chełmińska M9, Ebner B10, Frelih N11, Gawlik R12, Gelincik A13, Hawranek T14, Hoetzenecker W15, Jiménez Blanco A16, Kita K9, Kendirlinan R17, Košnik M18, Laipold K1, Lang R14, Marchi F19, Mauro M20, Nittner-Marszalska M21, Poziomkowska-Gęsicka I22, Pravettoni V23, Preziosi D20, Quercia O24, Reider N25, Rosiek-Biegus M21, Ruiz-Leon B26, Schrautzer C1, Serrano P26, Sin A27, Sin BA17, Stoevesandt J28, Trautmann A28, Vachová M29,30, Sturm GJ1,31

1Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
2Institute for Medical Informatics, Statistics, and Documentation, Medical University of Graz, Graz, Austria
3Allergy Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
4Servicio de Enfermedades del Sistema Inmune-Alergia, Hospital Universitario Príncipe de Asturias, Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain
5Servicio de Alergia, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
6Allergy Unit, Verona General Hospital, Verona, Italy
7Laboratorio Unico Metropolitano, Maggiore Hospital, Bologna, Italy
8Clinical Department of Internal Diseases, Dermatology, and Allergology, Medical University of Silesia, Zabrze, Poland
9Allergology Department, Medical University of Gdańsk, Gdańsk, Poland
10Department of Dermatology, General Hospital Ordensklinikum Linz GmbH Elisabethinen, Linz, Austria
11University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
12Department of Internal Medicine, Allergy, and Clinical Immunology, Silesian University of Medicine, Katowice, Poland
13Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
14Department of Dermatology and Allergology, Paracelsus Medical University Salzburg, Salzburg, Austria
15Department of Dermatology, Kepler University Hospital and Medical Faculty, Johannes Kepler University, Linz, Austria
16Allergy Unit, Hospital Central de la Cruz Roja. Faculty of Medicine, Alfonso X El Sabio University, ARADyAL, Madrid, Spain
17Department of Pulmonary Diseases, Division of Immunology and Allergy, Faculty of Medicine, Ankara University, Ankara, Türkiye
18University Clinic of Respiratory and Allergic Diseases, Golnik and Medical Faculty, Ljubljana, Slovenia
19SD Allergologia Clinica, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
20Allergy Unit, Sant'Anna Hospital, Como, Italy
21Department of Internal Diseases, Pulmonology and Allergology, Medical University of Wroclaw, Wroclaw, Poland
22Clinical Allergology Department, Pomeranian Medical University, Szczecin, Poland
23Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
24High Specialization Unit of Allergology, Hospital of Faenza, AUSL (Local Health Unit) of Romagna, Romagna, Italy
25Department of Dermatology, Venereology, and Allergology, Medical University of Innsbruck, Innsbruck, Austria
26Allergy Section of University Hospital Reina Sofia, ARADyAL Network, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
27Department of Internal Medicine, Division of Allergy and Immunology, Medical Faculty, Ege University, Izmir, Türkiye
28Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany
29Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
30Department of Immunology and Allergology, University Hospital Pilsen, Czech Republic
31Allergy Outpatient Clinic Reumannplatz, Vienna, Austria

J Investig Allergol Clin Immunol 2025; Vol 35(1) : 40-49
doi: 10.18176/jiaci.0967

Background: The safety profile of venom immunotherapy (VIT) is a relevant issue, and considerable differences have been reported in the safety and efficacy of this treatment modality. The primary aim of this study was to evaluate the safety of angiotensin-converting enzyme inhibitors and ß-blockers during VIT. In a second analysis, we evaluated data on premedication and venom preparations and their association with systemic adverse events (AEs) during the up-dosing phase and the first year of the maintenance phase, as well as the outcome of field stings and sting challenges.
Methods: Ours was an open, prospective, observational, multicenter study that recruited 1425 patients, of whom 1342 underwent VIT.
Results: Premedication with oral antihistamines was taken by 52.1% of patients during up-dosing and 19.7% of patients during the maintenance phase. Antihistamines had no effect on the frequency of systemic AEs (P=.11), although large local reactions (LLRs) were less frequent (OR, 0.74; 95%CI, 0.58-0.96; P=.02). Aqueous preparations were preferred for up-dosing (73.0%), and depot preparations were used for the maintenance phase (64.5%). The type of venom preparation had no influence on the frequency of systemic AEs or on the effectiveness of VIT (P=.26 and P=.80, respectively), while LLRs were less frequent with depot preparations (P<.001).
Conclusions: Pretreatment with oral antihistamines during VIT significantly reduces the frequency of LLRs but not systemic AEs. All venom preparations were equally effective and did not differ in terms of the frequency of systemic AEs.

Key words: Anaphylaxis, Bee venom, Effectiveness, Premedication, Systemic adverse events, Venom immunotherapy, Venom preparation, Vespid venom