Outcome of bee and wasp venom immunotherapy (VIT) in a major allergy center in the UK

Abstract

Rationale VIT is effective for the therapy of insect venom anaphylaxis, but a proportion of patients continue to have severe reactions despite therapy. The aim of this study was to estimate the incidence of failed responses and to assess the overall effects of VIT on patients' use of emergency medication and quality of life (QOL). Methods A postal questionnaire was sent to 195 adult patients with severe systemic reactions to wasp or bee stings with positive specific IgE who had completed a course of appropriate VIT (Pharmalgen, ALK, Denmark) within the past 10 years. Results 125 (64%) of the total patients responded. 103 (51M, 52F) completed wasp VIT (77% >3 yr course). 85 (83%) continued to carry adrenaline following completion of VIT. 45 (44%) subsequently received a field sting. Of these, 8 (18%) reported a severe systemic reaction requiring ER attendance and/or use of emergency adrenaline. The remainder experienced no reaction or a milder reaction. 22 (12M, 10F) completed bee VIT (68% >3 yr course). 14 (64%) continued to carry adrenaline. 8 (36%) received a field sting, of which 0 (0%) was severe. Of those who commented on QOL, 100% (wasp) and 94% (bee) reported subjective improvement following VIT. Conclusions The incidence of severe systemic reactions to field stings following wasp and bee VIT in our series is low but tangible. Although treated patients almost universally report improved QOL, a majority continue to carry emergency therapy. The data provide support for this policy at least until the first field sting.