Rush hyposensitization with Hymenoptera venoms. Tolerance and results of therapy

Abstract

During 290 courses of rush hyposensitization with bee or wasp venoms performed on an in-patient basis there were systemic anaphylactic side effects in 38% before the maintenance dose of 100 micrograms was reached. These reactions were usually mild, occurred mostly at higher venom doses (threshold doses greater than or equal to 1 microgram in about 75%) and were more frequent (P less than 0.05) in patients with a history of a full shock due to stings than in individuals with milder symptoms. Furthermore, systemic anaphylactic side effects occurred more often (P less than 0.01) in bee venom allergic patients with a greater sensitivity in the prick test (threshold less than 10 micrograms/ml) than in those being less reactive; no such dependence was found in wasp venom allergy. RAST results were not correlated to the occurrence of systemic anaphylactic side effects. Evaluation of the therapeutic effect was performed by 163 sting challenge tests, which caused only local sting reactions in 80%. Compared to prior stings improvement of symptoms was achieved in 95% of 157 patients with a history of systemic reactions. Individuals with more severe challenge reactions were older (P less than 0.05) than those with merely generalized skin symptoms. Furthermore, there was a correlation between the occurrence of systemic challenge reactions and systemic anaphylactic side effects during rush hyposensitization as well as between a history of more severe sting reactions and symptoms exceeding generalized skin symptoms at challenge. Thus, hyposensitization with hymenoptera venoms induces partial or complete protection in a high percentage of patients. The course of rush hyposensitization as well as the therapeutic effect depend to some degree on the original intensity of hypersensitivity.