Predictors of side effects during the buildup phase of venom immunotherapy for Hymenoptera venom allergy: The importance of baseline serum tryptase† - 07/08/11
, Bernhard Przybilla, MD a, Maria Beatrice Biló, MD c, Ulrich Müller, MD d, Fabian Scheipl, MSc b, Werner Aberer, MD e, Joëlle Birnbaum, MD f, Anna Bodzenta-Lukaszyk, MD g, Floriano Bonifazi, MD c, Christoph Bucher, MD h, Paolo Campi, MD i, Ulf Darsow, MD j, Cornelia Egger, MD k, Gabrielle Haeberli, MD d, Thomas Hawranek, MD l, Iwona Kucharewicz, MD g, Helmut Küchenhoff, PhD b, Roland Lang, PhD l, Oliviero Quercia, MD m, Norbert Reider, MD k, Maurizio Severino, MD i, Michael Sticherling, MD n, Gunter Johannes Sturm, MD e, Brunello Wüthrich, MD h
Reprint requests: Franziska Ruëff, MD, Klinik und Poliklinik für Dermatologie und Allergologie, AllergieZentrum, Ludwig-Maximilians-Universität München, Frauenlobstr 9-11, D-80337 Munich, Germany.Abstract |
Background |
Severe side effects during venom immunotherapy (VIT) are associated with a variety of risk factors.
Objective |
Our aim was to evaluate the association of baseline serum tryptase concentration (BTC) and of other parameters, which are routinely recorded during patient evaluation, with the frequency of severe reactions requiring an emergency intervention during the buildup phase of VIT.
Methods |
In this observational prospective multicenter study, we enrolled 680 patients with established honeybee or vespid venom allergy who underwent VIT. Data were collected on tryptase concentration, age, sex, culprit insect, cardiovascular medication, degree of preceding sting reaction, preventive antiallergic medication before therapy, time between last preceding sting reaction and VIT, venom specific IgE concentration, and type of buildup procedure. Relative rates were calculated with generalized additive models.
Results |
Fifty-seven patients (8.4%) required an emergency intervention during buildup because of a severe systemic reaction. The frequency of interventions increased significantly with higher BTC (log-linear association; adjusted odds ratio, 1.56; 95% CI, 1.15-2.11; P < .005). The predictive power of BTC was markedly greater when VIT was performed for vespid venom allergy than for bee venom (for bee VIT, no significant association; for vespid VIT, log-linear association; adjusted odds ratio, 2.33; 95% CI, 1.28-4.26; P = .005). The most important other factor significantly associated with severe reactions during the buildup phase of VIT was bee venom allergy.
Conclusion |
Before vespid VIT, measurement of baseline serum tryptase concentration should be used to identify patients with a high risk for side effects. Patients with bee venom allergy require a particularly high degree of surveillance during VIT.
Le texte complet de cet article est disponible en PDF.Key words : Hymenoptera venom, allergy, venom immunotherapy, tryptase, risk factors, ACE inhibitor, age, sex
Abbreviations used : ACE, BTC, EAACI, GAM, ln, ROC, VIT
Plan
| †A study of the European Academy of Allergy and Clinical Immunology Interest Group on Insect Venom Hypersensitivity. |
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| Supported (collection of the data) by Phadia, Freiburg, Germany, and ALK-Abelló, Wedel, Germany. |
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| Disclosure of potential conflict of interest: F. Ruëff has given paid lectures for and received honoraria for participation in clinical studies from HAL and has received research support from Artu Biologicals and Novartis. B. Przybilla has received honoraria from ALK-Abelló, Stallergenes, and Novartis; has received research support from Informationsverbund Dermatologischer Kliniken; and is the treasurer of the German Society of Allergology and Clinical Immunology. M. B. Biló has received lecture honoraria from Stallergenes. W. Aberer has received research support from Jerini. A. Bodzenta-Lukaszyk has received lecture honoraria from HAL. F. Bonifazi has received lecture honoraria from Phadia. T. Hawranek has given paid lectures for and participated in studies for ALK-Abelló. I. Kucharewicz has received lecture honoraria from HAL. The rest of the authors have declared that they have no conflict of interest. |
Vol 126 - N° 1
P. 105 - juillet 2010 Retour au numéro
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