Abstract
BackgroundAn experienced life-threating anaphylactic reaction to hymenoptera venom can sustainably impair patients’ quality of life (QoL). Besides carrying emergency medication, venom-specific immunotherapy (VIT) exists as a causal treatment of allergy. ObjectiveThis study aimed to examine QoL, anxiety, depression, and physical and mental health in patients allergic to hymenoptera venom before and during VIT and the impact of a tolerated sting challenge (SC). MethodsBetween July 2017 and August 2017, 142 patients with venom allergy were analyzed using validated questionnaires as the: Vespid Allergy Quality for Life Questionnaire" (VQLQ-d), the "Hospital Anxiety and Depression Scale" (HADS-D) and the "Short Form 36" (SF-36). To evaluate the impact of VIT and SC on the QoL, patients were divided into 3 groups: (A) VIT and tolerated SC (n = 45), (B) VIT before carrying out SC (n = 73), and (C) therapy-naïve before VIT (n = 20). Further parameters like gender, age, insect species, and severity of the anaphylactic reaction were assessed. ResultsA significant correlation between the health-related QoL and the parameters of gender and state of treatment was seen. Especially male patients, as well as patients allergic to yellow jacket venom, benefit from a SC in terms of a significant increase in their QoL. In the total study cohort, a clear trend was observed towards a higher QoL in patients under VIT who tolerated a SC. Overall, neither the patients’ age nor the insect species exerted a relevant influence on QoL, depression or anxiety. However, women showed a lower QoL combined with higher anxiety and depression scores than men. ConclusionImmunotherapy leads to an improved QoL, which can be further increased by a SC. A tolerated SC conceivably reassures the patients by objectifying the treatment success. Female patients appear to have a stronger impaired QoL per se. Taken together, a SC can be performed during VIT to strengthen the patients’ QoL.
Highlights
Systemic allergic reactions to hymenoptera venom occur in 0.3–7.5% of adults, large local reactions at the sting site are common in up to 26% of the population.[1,2] Due to the potentially life-threating risk of an anaphylactic reaction, those affected by systemic allergic reactions can suffer from a severely impaired quality of life (QoL).[3,4] both the patients’ physical health and mental well-being should be addressed by an adequate treatment.One common emergency tool used to reduce the imminent lethal threat after a sting is epinephrine autoinjectors for self-administration
Immunotherapy leads to an improved QoL, which can be further increased by a sting challenge (SC)
This study provides real-life data on QoL in patients with hymenoptera venom allergy in relation to their state of therapy
Summary
One common emergency tool used to reduce the imminent lethal threat after a sting is epinephrine autoinjectors for self-administration Carrying these autoinjectors at all times is experienced as burdensome;[5,6] more alarmingly, a considerable number of patients are insufficiently educated and equipped.[7] In contrast, venom-specific immunotherapy (VIT) is a causal therapeutic approach that prevents the risk of a repeated allergic reaction in advance as well as provides an effective treatment in 77–84% of bee venom allergy patients and 91–96% of yellow jacket venom allergy patients.[8,9,10] As reviewed by Dhami et al,[11] VIT has been proven to be a safe procedure for both adults and children. Venomspecific immunotherapy (VIT) exists as a causal treatment of allergy
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