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Hymenoptera Venom Allergy: Management of children and adults in clinical practice

Bilò MB1, Pravettoni V2, Bignardi D3, Bonadonna P4, Mauro M5, Novembre E6, Quercia O7, Cilia M8, Cortellini G9, Costantino MT10, Cremonte L11, Rizzini FL12, Macchia L13, Marengo F14, Murzilli F15, Patella V16, Reccardini F17, Ricciardi L18, Ridolo E19, Romano A20, Savi E21, Schiavino D22, Severino M23, Pastorello EA24

1U.O.C. Allergology, Department of Internal Medicine, University-Hospital Ospedali Riuniti di Ancona, Italy
2U.O.C. General Medicine – Immunology and Allergology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
3U.O.C. Allergology, Ospedale Policlinico San Martino, Genova, Italy
4U.S.D. Allergology Integrated University-Hospital of Verona, Italy
5U.O.S. Allergology Hospital S. Anna Como ASST Lariana, Italy
6Complex Organizational Unit of Allergology, University-Hospital A. Meyer, Firenze, Italy
7High Specialization Unit of Allergology, Hospital of Faenza, AUSL (Local Health Unit) of Romagna, Italy
8Allergology Practice, C.d.S. of Scilla, Reggio Calabria, Italy
9Allergology, O.U. Internal Medicine and Rheumatology, Rimini, Local Health Unit of Romagna, Italy
10Departmental Structure Day Hospital Center, Allergology and Clinic Immunology Local Health Unit of Mantova, Intercompany Allergology ATS Val Padana, Italy
11SS Allergologia ASL AL Alessandria, Italy
12S.S.V.D Allergology Civil Hospitals of Brescia, Department of Clinical and Experimental Sciences University of Brescia, Italy
13School and Chair of Allergology and Clinical Immunology, University of Bari, Italy
14Allergology and Clinical Immunology, A.O.U. Città della Salute e della Scienza di Torino
15U.O.S.D. of Allergology Hospital S.S. Filippo and Nicola, Avezzano (AQ), Italy
16Allergy and Clinical Immunology Division, Department of Medicine, Civil Hospital of Battipaglia, Salerno, Italy
17SOC Pneumology, Respiratory Physiopathology, integrated University Health Authority of Udine, Italy
18Allergy and Clinical Immunology Unit - University Hospital AOU Policlinico G.Martino, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
19Department of Medicine and Surgery, University of Parma, Italy
20Unit of Allergology, Presidio Columbus, Rome, Italy
21Operating Departmental Unit of Allergology, Hospital G. Da Saliceto, Piacenza, Italy
22Complex Operating Unit of Allergology, Policlinico Gemelli – School of Specialization in Allergology and Clinical Immunology, Catholic University, Rome, Italy
23Allergy Unit, San Giovanni di Dio Hospital, Florence, Italy
24Complex Unit of Allergology and Immunology at ASST Grande Ospedale Metropolitano Niguarda - School of Specialization in Allergology and Clinical Immunology at University of Milan, Italy

J Investig Allergol Clin Immunol 2019; Vol. 29(3)
doi: 10.18176/jiaci.0310

Hymenoptera venom allergy is an epidemiologically underestimated condition representing an important cause of morbidity worldwide. Preventing future allergic reactions in patients who have developed a systemic reaction is based on the correct management of emergency followed by a correct diagnosis, prescription of adrenaline autoinjectors and, where indicated, specific venom immunotherapy (VIT). Some epidemiological studies highlight the poor knowledge of this disease and the frequent inadequacy of its management. Moreover, they emphasize the importance of such a life-saving treatment as specific immunotherapy. The availability of high quality Hymenoptera venom extracts for diagnostic and therapeutic use has dramatically improved the prognosis and the quality of life of allergic patients. The subcutaneous VIT represents the most effective form of immunotherapy with allergen presently available, with a carry-over effect lasting up to several years after its interruption.
This report on the management of children and adults allergic to Hymenoptera venom was drawn up by a panel of Italian experts.
The main objective of this consensus is to review the scientific evidences related to diagnosis, therapy and management of patients allergic to Hymenoptera venom and is aimed to improve the knowledge about this disease and promote good clinical practices. Practical suggestions for a correct diagnosis, prescription of emergency therapy and immunotherapy, as well as strategies for taking care of patients' management are included.

Key words: Adults, Children, Diagnosis, Efficacy, Hymenoptera, Immunotherapy, Management, Safety