EFFICACY OF VENOM IMMUNOTHERAPY IN PATIENTS WITH LARGE LOCAL REACTIONS TO STINGS

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。对膜翅目昆虫毒液皮肤试验阳性的蜇伤有全身性过敏反应史的个体适用毒液免疫治疗。使用毒液免疫疗法的原因包括：降低死亡率、减轻疼痛和痛苦、减少不便、增加旅行自由和在各种环境中保持正常活动水平、减少被蛰伤后从学校和/或工作中损失的时间，以及降低成本。除了死亡率的问题外，还有一种观点认为，有严重局部过敏反应史的人也可以出于同样的原因从毒液免疫疗法中受益。除了一个单一的病例史（作为本研究的前奏），没有关于毒液免疫疗法对有蜇伤大局部反应史的患者的疗效的公开报道，尽管有两个摘要报告表明其效用。本研究的目的有三个方面：1)确定以前对蜜蜂叮咬有较大局部反应的个体发生全身过敏反应的风险；2)确定毒液免疫疗法是否减少了蜜蜂叮咬引起的大面积局部反应的频率或严重程度；3)确定是否可以通过免疫指标或对膜翅目毒液反应性的临床指标来预测刺痛过敏反应的风险。2005年，我们对皮肤试验呈阳性和有严重局部反应史的昆虫叮咬过敏患者进行了调查。共有28组预约，28次实际刺痛挑战，28次刺痛挑战中有14次是重复挑战，其中8次是第一次被刺痛。在8名新患者中，6名符合条件，6名将接受第二次穿刺。到10月，所有新患者都接受了VIT治疗。

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. Venom immunotherapy is indicated in individuals with a history of systemic allergic reactions to stings with positive skin tests to Hymenoptera venoms. Among the reasons for venom immunotherapy are: reduction in fatality, decreased pain and suffering, reduction in inconvenience, increased freedom to travel and maintain normal levels of activity in a variety of settings, reduced time lost from school and/or work following a sting, and cost. Aside from the issue of mortality, and argument could be made that individuals with a history of large local allergic reactions could benefit from venom immunotherapy for the same reasons. Aside from a single case history (published as the prelude to the present study) there are no published reports regarding the efficacy of venom immunotherapy in patients with a history of large local reactions to stings, though there have been two abstract presentations suggesting its utility. The purpose of the present study is threefold: 1) To determine the risk of systemic allergic reaction in individuals with previous large local reactions to bee stings; 2) To determine whether venom immunotherapy reduces the frequence or severity of large local reactions to bee stings and ; 3) To determine whether the risk of sting anaphylaxis can be predicted by any index of immunologic or clinical markers of reactivity against the Hymenoptera venoms. During the year 2005, we sting challenged insect allergic patients with positive skin tests and a history of a large local reaction. There were 28 set appointments with 28 actual sting challenges, Of the 28 sting challenges there were 14 repeat challenges, with 8 pts being stung for the first time. Of the 8 new patients 6 qualified with these 6 coming in for a second sting. By October all new patients were on VIT.