In:
Clinical & Experimental Allergy, Wiley, Vol. 44, No. 5 ( 2014-05), p. 736-746
Abstract:
Treatment failure during venom immunotherapy ( VIT ) may be associated with a variety of risk factors, of which the relative importance is unknown. Objective Our aim was to evaluate the association of baseline serum tryptase concentration ( BTC ), mastocytosis in the skin ( MIS ) and of other parameters with the frequency of objective systemic reactions during in‐hospital sting challenge ( SC ). Methods In this observational retrospective study, we enrolled 1532 patients (1609 cases due to double SC ) with established honeybee or vespid venom allergy who had undergone VIT and a subsequent SC . Data were collected on various putative risk factors. Adult‐onset MIS and/or a BTC 〉 20.0 μg/L was defined as clinical indicators of systemic mastocytosis. Relative rates were calculated with logistic regression models. Results Ninety‐eight patients (6.4%) presented with MIS and/or BTC 〉 20.0 μg/L. 104 cases (6.5%) developed objective generalized symptoms during SC . In the absence of MIS , a BTC ≤ 20 μg/L did not increase the risk for VIT failure. The most important factors associated with a worse outcome were ACE inhibitor medication ( OR 5.24, 95% CI 1.83–13.00, P 〈 0.001), honeybee venom allergy ( OR 5.09, 95% CI 3.17–8.15, P 〈 0.001), systemic allergic reaction during VIT ( OR 3.07, 95% CI 1.79–5.14, P 〈 0.001), and a substantial likelihood to suffer from SM ( OR 2.74, 95% CI 1.37–5.22, P = 0.003), whereas a double VIT ( OR 0.51, 95% CI 0.27–0.90, P = 0.027) and a longer duration of therapy ( OR 0.68 per treatment month, 95% CI 0.50–0.93, P = 0.017) reduced the failure rate. Conclusion The magnitude of therapeutic success correlates with type of venom, duration of therapy, and venom dose. Adult‐onset MIS and/or a BTC 〉 20 μg/L is a significant, albeit not the strongest determinant for VIT failure. According to its odds ratio, ACE inhibitor therapy appears to be associated with the highest risk for VIT failure.
Type of Medium:
Online Resource
ISSN:
0954-7894
,
1365-2222
DOI:
10.1111/cea.2014.44.issue-5
Language:
English
Publisher:
Wiley
Publication Date:
2014
detail.hit.zdb_id:
2186232-1
detail.hit.zdb_id:
2004469-0
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