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Insect Venom Immunotherapy: Analysis of the Safety and Tolerance of 3 Buildup Protocols Frequently Used in Spain

Gutiérrez Fernández D1, Moreno-Ancillo A2, Fernández Meléndez S3, Domínguez-Noche C4, Gálvez Ruiz P5, Alfaya Arias T6, and the remaining members of the SEAIC Committee on Allergy to Hymenoptera: Carballada González FJ, Alonso Llamazares A, Marques Amat LL, Vega Castro A, Antolín Amérigo D, Cruz Granados S, Ruiz León B, Sánchez Morillas L, Fernández Sánchez J, Soriano Gomis V, Borja Segade JM, Dalmau Duch G, Guspi Bori R, Miranda Páez A

1Servicio Neumología-Alergia, Hospital Universitario Puerta Mar, Cádiz, Spain
2Servicio de Alergología, Hospital Nuestra Señora del Prado, Talavera de la Reina, Spain
3Servicio de Alergología, Hospital Regional Carlos Haya, Málaga, Spain
4Servicio Alergología, Hospital Virgen Puerto, Plasencia, Spain
5Facultad de Educación, Universidad Internacional de La Rioja, Spain
6Servicio Alergología, Hospital General Universitario, Ciudad Real, Spain

J Investig Allergol Clin Immunol 2016; Vol 26(6) : 366-373
doi: 10.18176/jiaci.0073

Introduction: Hymenoptera venom immunotherapy (VIT) is an effective treatment but not one devoid of risk, as both local and systemic adverse reactions may occur, especially in the initial phases. We compared the tolerance to 3 VIT buildup protocols and analyzed risk factors associated with adverse reactions during this phase.

Materials and Methods: We enrolled 165 patients divided into 3 groups based on the buildup protocol used (3, 4, and 9 weeks). The severity of systemic reactions was evaluated according to the World Allergy Organization model. Results were analyzed using exploratory descriptive statistics, and variables were compared using analysis of variance.

Results: Adverse reactions were recorded in 53 patients (32%) (43 local and 10 systemic). Local reactions were immediate in 27 patients (63%) and delayed in 16 (37%). The severity of the local reaction was slight/moderate in 15 patients and severe in 13. Systemic reactions were grade 1-2. No significant association was found between the treatment modality and the onset of local or systemic adverse reactions or the type of local reaction. We only found a statistically significant association between severity of the local reaction and female gender. As for the risk factors associated with systemic reactions during the buildup phase, we found no significant differences in values depending on the protocol used or the insect responsible.

Conclusions: The buildup protocols compared proved to be safe and did not differ significantly from one another. In the population studied, patients undergoing the 9-week schedule presented no systemic reactions. Therefore, this protocol can be considered the safest approach.

Key words: Allergy, Immunotherapy, Insect venom immunotherapy, Buildup protocols, Systemic reaction, Local reaction, Hymenoptera, Apis mellifera, Vespula species, Polistes species.