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

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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. 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.