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

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。毒液免疫治疗适用于对刺痛有全身过敏反应史且对膜翅目毒液皮肤测试呈阳性的个人。毒液免疫治疗的原因包括：减少死亡率，减少疼痛和痛苦，减少不便，增加旅行自由并在各种环境中保持正常活动水平，减少被叮咬后从学校和/或工作中损失的时间，以及成本。除了死亡率的问题外，还可以认为，出于同样的原因，有较大局部过敏反应史的个人也可以从蛇毒免疫疗法中受益。除了一个单一的病例史(作为本研究的前奏发表)外，还没有关于蛇毒免疫疗法对有刺痛严重局部反应病史的患者的疗效的公开报道，尽管已经有两个抽象的陈述表明了它的有效性。本研究的目的有三个方面：1)确定对蜜蜂叮咬有较大局部反应的个体发生全身性过敏反应的风险；2)确定毒液免疫疗法是否降低了对蜜蜂叮咬产生较大局部反应的频率或严重程度；3)确定是否可以通过针对膜翅目毒液的免疫学或临床反应性标记物的任何指标来预测刺伤过敏反应的风险。在2005年，我们刺痛了皮肤测试呈阳性且有较大局部反应史的昆虫过敏患者。28次预约，28次实际刺痛挑战，28次刺痛挑战中有14次重复挑战，其中8分是首次刺痛。在8名新患者中，6名合格，这6名患者进行了第二次刺激。到10月份，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.