VOLUME 89 NUMBFR 2
43. Thompson PM, McLachlan SM, Pa&es A, Clark F, Howe1 D, Smith BR. The IgG subclass distribution of thyroglobulin antibody synthesize in culture. Stand J Immunol 1983;18: 123-9. 44. Anderson BR, Terry WD. Gamma GCglobulin antibody causing inhibition of clotting factor VIII. Nature 1968;217:174-5. 45. Bore1 Y. Isologous IgG-induced immunologic tolerance to haptens: a model of self versus non-self recognition. Transplant Rev 19?6;31:3-21.
46. Lee WY, Sebon AI-I. Suppression of reaginic ;intihodies. lmmunol Rev 1978;41:200-47. 47. Bernstein IL, Michael JG, Malkiel S. Sweet LC. Bracken RG. Immunoregulatory function of specific IgG. II. Clinical evaluation of combined active and passive Immunotherapy. Int Arch Allergy Appl Immunol 1979;58:30-7. 48. Tamir R, Castracane JM, Roclclin RE. Generation of suppressor cells in atopic patients during immunotherapy that modulate IgE synthesis. J ALLERGY CLIN IMMIJE~OI 19X7.‘YSL’i X
w jacket venom is Y efficacy and safety Ulrich Miiller, Bern,
Switzerland,
MD,* Arthur
Helbling,
and New Orleans,
MD,**
and Emanuel
WrchWd,*
MD
La.
Venom immunotherapy (VIT) for Hymenoptera allergy is accepted as safe and effective, However, widely varying success rates and frequencies of side effects are reported. Dtrerences between various Hymenoptera species could account for these diverging results. We therefore analyzed 205 patients with a history of systemic allergic reactions to either honeybee (148 patients) or yellow jacket stings (57 patients) during VIT. All patients had a positive skin test to the respective venom before VIT, were monitored for side effects of VIT, and submitted to N sting challenge while they were receiving VIT. Patients with honeybee-venom allergy had a higher sensitivi@ in both skin tests (p < 0.05) and RAST (p < 0.001) than patients with yellow jacket-venom allergy. They developed systemic side effects to VIT injections sign$cantly more often (41% versus 25%; p < 0.01) and also reacted more frequently to the sting challenge (2.?% versus 9%; p < 0.01) than patients with yellow jacket-venom allergy. We conclude that results obtained from studies on the allergy to one Hymenoptera venom cannot be extrapolated to allergies to other Hymenoptera venoms. (J ALLERGY CLIN IMMUNOL 1992;89:529-35.) Key words: Hymenoptera-sting immunotherapy
allergy, honeybee venom, yellow jacket venom, venom
VIT is accepted as a safe and effective treatment for patients with allergic SRs after Hymenoptera stings. I-3 However, widely varying success rates are reported from different centers. According to a CH
From tbe *Medical Division, Zieglerspital, Bern, Switzerland, **Division of Clinical Immunology and Allergy, Tulane versity School of Medicine, New Orleans, La. Received for publication Feb. 21, 1991. Revised Aug. 21, 1991. Accepted for publication Sept. 4, 1991. Reprint requests: Ulrich R. Miiller, MD, Medical Division, glerspital, CH-3007 Bern, Switzerland. l/1/33620
and Uni-
Abbreviations VIT:
SE: SSE: OSE: HB: YJ: HBV:
Zie-
YJV: EPC: CH: SR:
used
immunotherapy Systemic allergic side effects Subjective SE Objective SE Honeybee Yellow jacket (Vespula sp)
Venom
Honeybee
venom
Yellow jacket venom End point concentration Sting chaIlenge Systemic reaction J 529
530
Miiller
TABLE
J. ALLERGY CLIN. IMMUNOL. FEBRUARY 1992
et al.
I. Clinical
Parameter
HBV
No. of pts Mean age ? SD (raw) M F Severity of SR* Grade II Grade III Grade IV Duration of VIT to CH in months + SD bw)
Immunotherapy
data of the patients allergy
148 32.4
+ 13.38 (8-71) 98 (66) 50 (34)
14 (19) 74 (SO) 60 (41) 46.85t k 33.45 (lt-168)
YJV
allergy
51 34.37 k (10-64)
13.05
28 (49) 29 (51) 7 (13) 31 (54) 19 (33) 60.16 r 21.3 (34-121)
Pfs, Patients. *Miiller” and Mueller? grade I, urticaria, itching, malaise; grade II, any of the above plus two or more of the following: angioedema, constriction in chest, nausea, vomiting, diarrhea, abdominal pain, or dizziness; grade III, any of the above plus two or more of the following: dyspnea, wheezing, stridor, dysphagia, dysarthria, or hoarseness; grade IV, any of the above plus two or more of the following: fall in blood pressure, collapse, loss of consciousness, incontinence, or cyanosis. tEarly CH in 36 beekeepers.
protocol
VIT was started by either a rush protocol (56 patients receiving HBV and 21 receiving YJV venom) with four daily injections, reaching the maintenance dose of 100 kg in 3 to 5 days, or by a conventional protocol (92 patients receiving HBV and 36 receiving YJV venom) with weekly sessions, reaching the maintenance dose of 100 p,g after 12 weeks as a rule. In beekeepers and in patients with an insufficient increase of venom-specific IgG to
43. Thompson PM, McLachlan SM, Pa&es A, Clark F, Howe1 D, Smith BR. The IgG subclass distribution of thyroglobulin antibody synthesize in culture. Stand J Immunol 1983;18: 123-9. 44. Anderson BR, Terry WD. Gamma GCglobulin antibody causing inhibition of clotting factor VIII. Nature 1968;217:174-5. 45. Bore1 Y. Isologous IgG-induced immunologic tolerance to haptens: a model of self versus non-self recognition. Transplant Rev 19?6;31:3-21.
46. Lee WY, Sebon AI-I. Suppression of reaginic ;intihodies. lmmunol Rev 1978;41:200-47. 47. Bernstein IL, Michael JG, Malkiel S. Sweet LC. Bracken RG. Immunoregulatory function of specific IgG. II. Clinical evaluation of combined active and passive Immunotherapy. Int Arch Allergy Appl Immunol 1979;58:30-7. 48. Tamir R, Castracane JM, Roclclin RE. Generation of suppressor cells in atopic patients during immunotherapy that modulate IgE synthesis. J ALLERGY CLIN IMMIJE~OI 19X7.‘YSL’i X
w jacket venom is Y efficacy and safety Ulrich Miiller, Bern,
Switzerland,
MD,* Arthur
Helbling,
and New Orleans,
MD,**
and Emanuel
WrchWd,*
MD
La.
Venom immunotherapy (VIT) for Hymenoptera allergy is accepted as safe and effective, However, widely varying success rates and frequencies of side effects are reported. Dtrerences between various Hymenoptera species could account for these diverging results. We therefore analyzed 205 patients with a history of systemic allergic reactions to either honeybee (148 patients) or yellow jacket stings (57 patients) during VIT. All patients had a positive skin test to the respective venom before VIT, were monitored for side effects of VIT, and submitted to N sting challenge while they were receiving VIT. Patients with honeybee-venom allergy had a higher sensitivi@ in both skin tests (p < 0.05) and RAST (p < 0.001) than patients with yellow jacket-venom allergy. They developed systemic side effects to VIT injections sign$cantly more often (41% versus 25%; p < 0.01) and also reacted more frequently to the sting challenge (2.?% versus 9%; p < 0.01) than patients with yellow jacket-venom allergy. We conclude that results obtained from studies on the allergy to one Hymenoptera venom cannot be extrapolated to allergies to other Hymenoptera venoms. (J ALLERGY CLIN IMMUNOL 1992;89:529-35.) Key words: Hymenoptera-sting immunotherapy
allergy, honeybee venom, yellow jacket venom, venom
VIT is accepted as a safe and effective treatment for patients with allergic SRs after Hymenoptera stings. I-3 However, widely varying success rates are reported from different centers. According to a CH
From tbe *Medical Division, Zieglerspital, Bern, Switzerland, **Division of Clinical Immunology and Allergy, Tulane versity School of Medicine, New Orleans, La. Received for publication Feb. 21, 1991. Revised Aug. 21, 1991. Accepted for publication Sept. 4, 1991. Reprint requests: Ulrich R. Miiller, MD, Medical Division, glerspital, CH-3007 Bern, Switzerland. l/1/33620
and Uni-
Abbreviations VIT:
SE: SSE: OSE: HB: YJ: HBV:
Zie-
YJV: EPC: CH: SR:
used
immunotherapy Systemic allergic side effects Subjective SE Objective SE Honeybee Yellow jacket (Vespula sp)
Venom
Honeybee
venom
Yellow jacket venom End point concentration Sting chaIlenge Systemic reaction J 529
530
Miiller
TABLE
J. ALLERGY CLIN. IMMUNOL. FEBRUARY 1992
et al.
I. Clinical
Parameter
HBV
No. of pts Mean age ? SD (raw) M F Severity of SR* Grade II Grade III Grade IV Duration of VIT to CH in months + SD bw)
Immunotherapy
data of the patients allergy
148 32.4
+ 13.38 (8-71) 98 (66) 50 (34)
14 (19) 74 (SO) 60 (41) 46.85t k 33.45 (lt-168)
YJV
allergy
51 34.37 k (10-64)
13.05
28 (49) 29 (51) 7 (13) 31 (54) 19 (33) 60.16 r 21.3 (34-121)
Pfs, Patients. *Miiller” and Mueller? grade I, urticaria, itching, malaise; grade II, any of the above plus two or more of the following: angioedema, constriction in chest, nausea, vomiting, diarrhea, abdominal pain, or dizziness; grade III, any of the above plus two or more of the following: dyspnea, wheezing, stridor, dysphagia, dysarthria, or hoarseness; grade IV, any of the above plus two or more of the following: fall in blood pressure, collapse, loss of consciousness, incontinence, or cyanosis. tEarly CH in 36 beekeepers.
protocol
VIT was started by either a rush protocol (56 patients receiving HBV and 21 receiving YJV venom) with four daily injections, reaching the maintenance dose of 100 kg in 3 to 5 days, or by a conventional protocol (92 patients receiving HBV and 36 receiving YJV venom) with weekly sessions, reaching the maintenance dose of 100 p,g after 12 weeks as a rule. In beekeepers and in patients with an insufficient increase of venom-specific IgG to
