EXTENDING VENOM IMMUNOTHERAPY MAINTENANCE INTERVALS

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Patients who have had a systemic allergic reaction to an insect sting and have positive venom skin tests are currently advised to undergo venom immunotherapy because of the perceived grave risk of life-threatening anaphylaxis to any future sting. Treatment is virtually 100% effective but is expensive and requires injections every 4-6 weeks for 5 years or more. Our recent studies have focused on whether treatment can be safely discontinued after 5 years. Although the risk of a systemic reaction to a sting is only 10% when venom immunotherapy is stopped after 5 years, the reaction (should it occur) could be life-threatening in those patients whose pre-treatment reactions were the most severe. These and other high-risk patients who may prefer to remain on therapy indefinitely, and who constitute approximately 20% of patients on venom immunotherapy, could achieve reduced cost and improved compliance if the number of injections per year could be reduced from the currently recommended 8 to 12 times per year down to just 3 or 4 times a year, without any increased risk of reaction to a sting (or an injection). Sting challenging occurred this summer with 3 patients participating. There were no systemic reactions during the sting challenges. These 3 patients had the option to extend or keep their treatment at every 20 weeks, with all agreeing.