Safety of 100\xa0\xb5g venom immunotherapy rush protocols in children compared to adults

Johanna Stoevesandt,Axel Trautmann,Andreas Kerstan,Christine Hosp

doi:10.1186/s13223-017-0204-y

Johanna Stoevesandt, Axel Trautmann + Show 2 more

Open Access

https://doi.org/10.1186/s13223-017-0204-y

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Abstract

BackgroundThere is a paucity of studies examining the safety of venom immunotherapy (VIT) in children. We aimed to assess the incidence of anaphylactic side effects during rush VIT in a cohort of pediatric patients and adult controls.Methods72 consecutive cycles of VIT-buildup in 71 children/adolescents aged 7–17 years were retrospectively evaluated and compared to an adult control group (n = 981) with regard to baseline parameters (sex, causative venom, severity of index sting reaction, results of allergy testing, comorbidities) and the incidence of anaphylactic adverse reactions.ResultsCompared to adults, severe index sting-induced anaphylaxis was significantly less common in children (P = .001). Children were more likely to suffer from bee venom allergy (P < .001) and showed higher levels of bee venom-specific IgE (P = .013), but lower serum tryptase concentrations (P = .014). The overall rate of VIT-induced anaphylactic reactions was higher in children than in adults (6.9% vs 2.5%, P = .046 by univariate analysis). In the final binary logistic regression model, however, only bee VIT (P = .039; odds ratio 2.25; confidence interval 1.04–4.87) and 5-day compared to 3-day buildup protocols (P = .011; odds ratio 2.64; confidence interval 1.25–5.57) were associated with an increased risk of treatment-induced anaphylaxis. All pediatric patients finally reached and tolerated the target maintenance dose of 100 µg.ConclusionsThe higher anaphylactic reaction rate observed in pediatric patients may be attributed to a greater prevalence of bee venom allergy. VIT-induced anaphylaxis in children is usually mild and does not affect further updosing and maintenance of VIT.

Highlights

There is a paucity of studies examining the safety of venom immunotherapy (VIT) in children
Sting-induced anaphylaxis commonly takes a benign course in pediatric patients, meaning that, first, reactions tend to be less severe than in adults [6,7,8] and, second, anaphylaxis is less likely to recur in the case of future re-stings [9]
A history of severe index sting reactions was documented in only 9.9% of cases compared to 26.5% in adults (P = .001)

Summary

Introduction

There is a paucity of studies examining the safety of venom immunotherapy (VIT) in children. Untreated children who have experienced moderate to severe index sting reactions, are at an increased risk of relapse compared to those with a history of urticaria or angioedema only, and the severity of recurring anaphylaxis was found to correspond to that of the initial reaction [10, 11]. Based on these observations, international guidelines state that venom immunotherapy (VIT) should be recommended for children with a history of moderate to severe sting-induced anaphylaxis, but not for those with only urticaria and/or angioedema [4, 5]

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