VENOM IMMUNOTHERAPY: SELECTIVE DESENSITIZATION

Abstract

<h3>Introduction</h3> A patient with venom anaphylaxis with IgE to paper wasp and honeybee, brought in hymenoptera identified as paper wasp and honeybee. We elected to desensitize to both, and not to other positive agents which were attributed to cross reactivity and agents not located in the region. <h3>Case Description</h3> A 70yoM presented after anaphylaxis to hymenoptera. He tested positive on serum venom IgE of 11.3 kU/L - paper wasp, >100 - honeybee, 2.12 - yellow jacket, 1.46 - white faced hornet; and <0.35 - yellow hornet. He brought in two specimens identified by clinic providers as a paper wasp and honeybee and underwent Rush venom immunotherapy to both agents which he tolerated well. He had subsequent field stings without systemic reaction. <h3>Discussion</h3> In patients with venom hypersensitivity, patient and exposure history remains the most important determinant in the decision for what agents to test and desensitize for. This patient tested positive to yellow jacket, not found in the region and thus was not likely the culprit and he did not bring in a white-faced hornet. It was decided they were not the likely cause of his anaphylaxis and therefore that it would be of little benefit to desensitize to these. We used exposure data to help identify what we desensitize the patient to. By selectively choosing agents based on history, we were able to desensitize the patient appropriately and avoided over utilization of health care expenses in the setting of venom shortages, by conserving the venom for testing and desensitization.