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Specific Immunotherapy in Hymenoptera Venom Allergy and concomitant Malignancies. A retrospective follow-up focusing on efficacy and safety

Aeberhard J1, Haeberli G1, Müller UR1, Helbling A1,2

1Allergy Unit Zieglerspital Clinic of Internal Medicine, Spital Netz Bern AG, Bern, Switzerland
2Division of Allergology, University Clinic of Rheumatology, Immunology & Allergology, Inselspital/University Hospital Bern, Switzerland

J Investig Allergol Clin Immunol 2018; Vol. 28(1)
doi: 10.18176/jiaci.0184

Introduction: Malignancies are often considered as a contraindication for allergen specific immunotherapy. This aspect must be discussed in regards to the population with severe Hymenoptera venom allergy and cancer. The aim of this retrospective study was to conduct a further examination of patients with Hymenoptera venom allergy, venom immunotherapy (VIT) and a malignancy.
Methodology: All patients have been included who were referred for evaluation of a Hymenoptera venom allergy or for control during VIT from January 1, 2004 to December 31, 2008.
Results: 2% of patients (51 of 2594) with a documented Hymenoptera venom allergy (25 female, 26 male; mean age 58 years) had an additional diagnosis of malignancy. 42 patients had VIT (82 %): 25 patients with a known cancer, 16 with new malignancy during VIT and one was diagnosed cancer after completed VIT. The most frequent type of tumour was breast cancer in female patients (60%) and prostate cancer in male patients (39%). 7% of patients with VIT developed systemic allergic reactions during VIT. 19 patients experienced a field sting or underwent a sting challenge test during VIT - 95 % tolerated the sting well. VIT was definitively halted in 9 patients: Due to new cancer in seven, one had a reactivation of cancer and one had a progressive polyneuropathy.
Conclusion: Efficacy and side effects of VIT in patients with Hymenoptera venom allergy and cancer are comparable to those without malignancy if cancer is in remission. This study shows that these patients are also eligible for VIT.

Key words: Allergy, Cancer, Hymenoptera venom allergy, Malignancy, Venom Immunotherapy