EXTENDING VENOM IMMUNOTHERAPY MAINTENANCE INTERVALS

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。对昆虫叮咬有全身过敏反应且毒液皮肤测试呈阳性的患者目前被建议接受毒液免疫治疗，因为人们认为未来任何叮咬都有危及生命的过敏反应的严重风险。治疗几乎100%有效，但费用昂贵，需要在5年或更长时间内每4-6周注射一次。我们最近的研究集中在5年后是否可以安全地停止治疗。尽管在5年后停止蛇毒免疫治疗时，被叮咬的全身反应的风险只有10%，但在那些治疗前反应最严重的患者中，这种反应(如果发生)可能会危及生命。这些和其他高危患者可能更愿意无限期地继续接受治疗，他们约占接受蛇毒免疫治疗的患者的20%，如果每年的注射次数可以从目前建议的每年8-12次减少到每年3-4次，而不会增加对叮咬(或注射)的反应风险，那么他们可以实现降低成本和改善依从性。今年夏天发生了刺痛挑战，有3名患者参加。在刺痛挑战期间，没有出现系统性反应。这3名患者可以选择每隔20周延长或保留他们的治疗，所有人都同意。

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.