EXTENDING VENOM IMMUNOTHERAPY MAINTENANCE INTERVALS

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。对昆虫蜇伤有全身性过敏反应且毒液皮肤试验呈阳性的患者，目前建议接受毒液免疫治疗，因为未来任何蜇伤都有严重的危及生命的过敏反应风险。治疗几乎100%有效，但价格昂贵，需要每4-6周注射一次，持续5年或更长时间。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年后停止毒液免疫治疗时，蜇伤引起全身反应的风险仅为10%，但对于那些治疗前反应最严重的患者，这种反应（如果发生）可能危及生命。如果每年的注射次数可以从目前推荐的每年8 - 12次减少到每年仅3 - 4次，而不会增加蜇伤（或注射）反应的风险，这些患者和其他高风险患者可能更愿意无限期地继续接受治疗，他们约占接受毒液免疫治疗患者的20%，就可以降低成本并提高依从性。今年夏天有3名患者参加了Sting挑战。在刺痛过程中没有出现全身反应。这3名患者可以选择每20周延长或继续治疗，所有患者都同意。

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.