RISK OF INSECT STING ANAPHYLAXIS AFTER DISCONTINUING VENOM IMMUNOTHERAPY

蛇毒免疫疗法降低对安非他明的全身过敏反应风险 昆虫叮咬从治疗前观察到的50%水平降至2%以下 接受维持治疗。在5年后或5年后停止治疗 更多的是，我们之前已经报道过被叮咬反应的风险 在停止治疗后的头几年仍然不到10%。 一些研究人员研究了在治疗仅3个月后停止治疗 多年来，但已建议限制，如较年轻的患者，较轻 反应、治疗中的负性刺痛挑战或负性RAST。 在停止治疗的前3年，我们的结果显示毒液皮肤 检测和免疫球蛋白E抗体水平逐渐变弱或呈阴性， 那些对刺痛有全身反应的患者有轻微症状。 甚至是一些微不足道的症状。大多数关于停用毒液的研究 免疫疗法仅在第一年报告了蜇伤的结果。 或停车后两次。目前还没有关于长期结果的报道 不接受治疗的患者。 我们假设几乎不会有反应的风险 停止治疗的患者随着时间的推移敏感性的消失 五年后。然而，最近的报告表明，这种风险可能会持续存在。 而前处理反应的严重程度可能是一个决定因素 反应的风险。 人们合理地认为，如果毒液是可以停止治疗的 皮肤测试或RAST变为阴性，这发生在少数 病人。然而，皮试对膜翅目的敏感性水平 毒液，最好的可用指标，与严重程度无关 对叮咬的临床反应，但还没有发现 比平均50%更准确地预测叮咬的结果 通过病史和皮试预测风险。这项研究的结果将 显示患者是否可以安全地在3年后停止治疗，而不是我们的 目前的建议为5-6年，以及是否存在反应风险 在停止治疗后的10年内保持在可接受的低水平。我们会 也要确定那些风险较低的患者是否存在较低的风险 在治疗前或在那些已经发展的人中有严重的反应史 皮肤测试和/或RAST呈阴性。

Venom immunotherapy reduces the risk of a systemic allergic reaction to an insect sting from the 50% level observed before treatment to less than 2% on maintenance therapy. When therapy is discontinued after 5 years or more, we have previously reported that the risk of a sting reaction remains less than 10% in the first few years after stopping treatment. Some investigators have studied discontinuation of therapy after only 3 years, but have suggested restrictions such as younger patients, milder reactions, negative sting challenge during therapy or negative RAST. In the first 3 years off therapy, our results showed that the venom skin test and IgE antibody levels became progressively weaker or negative, and the patients who did have systemic reactions to challenge stings had mild or even trivial symptoms. Most of the studies of discontinuing venom immunotherapy have reported the outcome of stings only in the first year or two after stopping. There are no reports of the long-term outcome in patients who remain off treatment. We hypothesized that there would become almost no risk of reaction with the disappearance of sensitivity over time in patients who stop treatment after 5 years. However, recent reports suggest that the risk may persisit and that the severity of the pre-treatment reaction may be a determinant of the risk of reaction. It has been reasonably assumed that treatment can be stopped if the venom skin test or RAST becomes negative, which occurs in a minority of patients. However, the level of skin test sensitivity to Hymenoptera venom, the best available indicator, does not correlate with the severity of the clinical reaction to a sting and no markers have been found to predict the outcome of a sting any more accurately than the average 50% risk predicted by history and skin test. The results of this study will show whether patients can safely stop after only 3 years instead of our current recommendation of 5-6 years, and whether the risk of reaction remains acceptably low in the 10 years after stopping therapy. We will also determine whether there is a lower risk in those patients with a less severe history of reaction before treatment or in those who have developed negative skin tests and/or RAST.