Article Text

EFFICACY OF IMMUNOTHERAPY IN CHILDREN WITH IGE-MEDIATED ANAPHYLAXIS TO HYMENOPTERA VENOM: ARE THEY PROTECTED ON RE-STING?
  1. A I Stritzke1,3,
  2. H P Gnehm1,
  3. P Eng2
  1. 1Children’s Hospital, Kantonsspital Aarau, Aarau, Switzerland
  2. 2Allergy Unit, Children’s Hospital Aarau and Lucerne, Aarau, Lucerne, Switzerland
  3. 3Department of Neonatology, University Hospital Bern, Bern, Switzerland

Abstract

Background Hymenoptera venom allergies in children are of concern because young patients are more prone to re-stings.

Objective This study aims to determine the protective effect of venom immunotherapy (VIT) with and without use of emergency rescue medication (ERM, i.e. oral antihistamines and steroids) to re-stings in childhood.

Methods 83 children with anaphylaxis to bee (n = 49), wasp (n = 29) or both hymenoptera venoms (n = 5) were included. Mean follow-up period was 7.7 years after commencement of VIT. We evaluated the number of re-stings, percentage of systemic reactions, number of patients carrying and taking ERM and its clinical efficacy in addition to VIT.

Results 49 children (59%) had been re-stung 108 times by the insect they were allergic to. The rate of re-stings was 0.23 per patient per year of follow-up with no difference between bee and wasp stings. 16% of children re-stung by bees developed immediate systemic reactions as compared to 6% of patients re-stung by wasps (p = 0.25). The majority of patients (87%) carried ERM, only 75% took it after re-sting. Children not taking ERM experienced significantly more frequent systemic allergic reactions to re-stings compared to those taking ERM (19% versus 4%, p<0.01). Furthermore, grades of systemic reactions were milder in children taking ERM in comparison to children not taking ERM after being re-stung.

Conclusions A majority of children are being re-stung. VIT provides complete protection in 94% with allergy to wasp venom and in 84% to bee venom. ERM provides adjunct therapy with reduced incidence and severity of systemic allergic reactions to re-stings.

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