Venom Immunotherapy
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《新英格兰医药杂志》
To the Editor: Golden and colleagues (Aug. 12 issue)1 report on the long-term benefits of venom immunotherapy in children with moderate-to-severe systemic reactions to insect stings. The optimal method for administration of venom immunotherapy in children is not known. Ultra-rush immunotherapy2 offers potential advantages over standard or slow protocols, including the need for fewer injections and more rapid achievement of protection.
We performed a retrospective analysis of children who were sensitized to honeybee venom (mean [±SD] age, 9±3 years) and who had a history of moderate-to-severe systemic reactions after bee stings. The children received either slow bee-venom immunotherapy (18 children) or modified ultra-rush bee-venom immunotherapy (82 children) through our clinics (Table 1). Ultra-rush immunotherapy in these children was as safe as the slow immunotherapy regimen. In addition, protective doses (50 μg) were achieved more rapidly with the ultra-rush protocol than with the slow protocol. The incidence of systemic adverse effects was substantially lower than that reported for rush bee-venom immunotherapy in adults.3
Table 1. Comparison of Ultra-Rush and Slow Protocols of Bee-Venom Immunotherapy in Children.
Louise Houliston, M.B., B.S.
Princess Margaret Hospital for Children
Subiaco, WA 6008, Australia
Isobel Brookes, M.B., Ch.B.
Fremantle Hospital
Fremantle, WA 6160, Australia
Dominic F. Mallon, M.B., B.S.
Princess Margaret Hospital for Children
Subiaco, WA 6008, Australia
References
Golden DBK, Kagey-Sobotka A, Norman PS, Hamilton RG, Lichtenstein LM. Outcomes of insect stings in children with and without venom immunotherapy. N Engl J Med 2004;351:668-674.
Jutel M, Skrbic D, Pichler WJ, Muller UR. Ultra rush bee venom immunotherapy does not reduce cutaneous weal responses to bee venom and codeine phosphate. Clin Exp Allergy 1995;25:1205-1210.
Westall GP, Thien FCK, Czarny D, O'Hehir RE, Douglass JA. Adverse events associated with rush Hymenoptera venom immunotherapy. Med J Aust 2001;174:227-230.
Dr. Golden replies: Prospective studies of the safety and efficacy of rush venom immunotherapy in adults and children have been published.1,2,3 Rush regimens with venoms actually seem to cause less frequent systemic reactions than slower regimens. The relative indication for such therapy varies in different settings. Some patients cannot conveniently visit the clinic weekly for 8 to 20 weeks, whereas others cannot devote 2 to 3 full days away from work for rush venom immunotherapy. In our report, we describe a remarkable duration of protection 10 to 20 years after venom immunotherapy administered during childhood. We used a regimen of six to eight weekly injections. Although ultra-rush venom immunotherapy is unlikely to induce immune tolerance at a rate greater than the 95 percent result we describe, it might suppress the venom allergy more rapidly than standard regimens of venom immunotherapy.4 The difference in mechanism and outcomes between immunotherapy and desensitization is not fully known.
David B.K. Golden, M.D.
Johns Hopkins University
Baltimore, MD 21224
dgolden1@jhmi.edu
References
Bernstein JA, Kagen SL, Bernstein DI, Bernstein IL. Rapid venom immunotherapy is safe for routine use in the treatment of patients with Hymenoptera anaphylaxis. Ann Allergy 1994;73:423-428.
Birnbaum J, Charpin D, Vervloet D. Rapid Hymenoptera venom immunotherapy: comparative safety of three protocols. Clin Exp Allergy 1993;23:226-230.
Thurnheer U, Muller UR, Stoller R, Lanner A, Hoigne R. Venom immunotherapy in Hymenoptera sting allergy: comparison of rush and conventional hyposensitization and observations during long-term treatment. Allergy 1983;38:465-475.
Bousquet J, Knani J, Velasquez G, Menardo JL, Guilloux L, Michel FB. Evolution of sensitivity to Hymenoptera venom in 200 allergic patients followed for up to 3 years. J Allergy Clin Immunol 1989;84:944-950.
We performed a retrospective analysis of children who were sensitized to honeybee venom (mean [±SD] age, 9±3 years) and who had a history of moderate-to-severe systemic reactions after bee stings. The children received either slow bee-venom immunotherapy (18 children) or modified ultra-rush bee-venom immunotherapy (82 children) through our clinics (Table 1). Ultra-rush immunotherapy in these children was as safe as the slow immunotherapy regimen. In addition, protective doses (50 μg) were achieved more rapidly with the ultra-rush protocol than with the slow protocol. The incidence of systemic adverse effects was substantially lower than that reported for rush bee-venom immunotherapy in adults.3
Table 1. Comparison of Ultra-Rush and Slow Protocols of Bee-Venom Immunotherapy in Children.
Louise Houliston, M.B., B.S.
Princess Margaret Hospital for Children
Subiaco, WA 6008, Australia
Isobel Brookes, M.B., Ch.B.
Fremantle Hospital
Fremantle, WA 6160, Australia
Dominic F. Mallon, M.B., B.S.
Princess Margaret Hospital for Children
Subiaco, WA 6008, Australia
References
Golden DBK, Kagey-Sobotka A, Norman PS, Hamilton RG, Lichtenstein LM. Outcomes of insect stings in children with and without venom immunotherapy. N Engl J Med 2004;351:668-674.
Jutel M, Skrbic D, Pichler WJ, Muller UR. Ultra rush bee venom immunotherapy does not reduce cutaneous weal responses to bee venom and codeine phosphate. Clin Exp Allergy 1995;25:1205-1210.
Westall GP, Thien FCK, Czarny D, O'Hehir RE, Douglass JA. Adverse events associated with rush Hymenoptera venom immunotherapy. Med J Aust 2001;174:227-230.
Dr. Golden replies: Prospective studies of the safety and efficacy of rush venom immunotherapy in adults and children have been published.1,2,3 Rush regimens with venoms actually seem to cause less frequent systemic reactions than slower regimens. The relative indication for such therapy varies in different settings. Some patients cannot conveniently visit the clinic weekly for 8 to 20 weeks, whereas others cannot devote 2 to 3 full days away from work for rush venom immunotherapy. In our report, we describe a remarkable duration of protection 10 to 20 years after venom immunotherapy administered during childhood. We used a regimen of six to eight weekly injections. Although ultra-rush venom immunotherapy is unlikely to induce immune tolerance at a rate greater than the 95 percent result we describe, it might suppress the venom allergy more rapidly than standard regimens of venom immunotherapy.4 The difference in mechanism and outcomes between immunotherapy and desensitization is not fully known.
David B.K. Golden, M.D.
Johns Hopkins University
Baltimore, MD 21224
dgolden1@jhmi.edu
References
Bernstein JA, Kagen SL, Bernstein DI, Bernstein IL. Rapid venom immunotherapy is safe for routine use in the treatment of patients with Hymenoptera anaphylaxis. Ann Allergy 1994;73:423-428.
Birnbaum J, Charpin D, Vervloet D. Rapid Hymenoptera venom immunotherapy: comparative safety of three protocols. Clin Exp Allergy 1993;23:226-230.
Thurnheer U, Muller UR, Stoller R, Lanner A, Hoigne R. Venom immunotherapy in Hymenoptera sting allergy: comparison of rush and conventional hyposensitization and observations during long-term treatment. Allergy 1983;38:465-475.
Bousquet J, Knani J, Velasquez G, Menardo JL, Guilloux L, Michel FB. Evolution of sensitivity to Hymenoptera venom in 200 allergic patients followed for up to 3 years. J Allergy Clin Immunol 1989;84:944-950.