TOPLINE:

A more than two-decade analysis of subcutaneous venom immunotherapy (VIT) in children with Hymenoptera venom allergy showed high safety, with only 0.4% systemic reactions (SRs) from 3739 total injections. The cluster protocol proved effective, with only 3.9% of re-stings resulting in SRs.

METHODOLOGY:

• Researchers conducted a retrospective analysis of medical charts from 58 children (median age, 9.4 years; 87.9% boys) with Hymenoptera venom allergy, followed up at the Allergy Unit of Meyer Children’s Hospital IRCCS, Florence, Italy, between 1997 and 2021.
• To confirm the diagnosis, skin prick tests (100 μg/mL; 0.1-10 μg/mL for severe cases), intradermal tests (0.001-1 μg/mL), and serum-specific immunoglobulin E measurements using the ImmunoCAP technique were performed.
• Adverse reactions (ARs) were classified as local reactions (LRs) if symptoms were confined to the sting site and resolved within 24 hours, extended local reactions (ELRs) if edema extended beyond 10 cm and lasted more than 24 hours, and SRs if multiple organs were involved.
• VIT followed a cluster protocol: a build-up phase targeting 100 μg/mL, followed by a maintenance dose of 100 μg/mL every 4 weeks initially, with intervals gradually extended to 6-8 weeks over the 5 years of treatment.

TAKEAWAY:

• Upon administration of 3739 injections, 9.5% ARs occurred: 8.2% LRs, 0.9% ELRs, and 0.4% SRs.
• Compared with the maintenance phase, the number of ARs reported during the build-up phase was significantly higher (P < .0001), particularly LRs.
• Of 51 re-stings reported by 30 patients, only two triggered SRs, both involving insects different from the treatment target.
• No factors such as sex, age, atopy, or severity of pretreatment reactions were linked to ARs during VIT.

IN PRACTICE:

“Our study suggests that despite the increased occurrence of mild LRs, the cluster protocol appears to be an optimal approach for administering VIT, as it balances faster treatment outcomes with a high safety profile. Although the cluster protocol was time-consuming for the patient, it did not require venous access placement, making it significantly better tolerated by patients and less resource-intensive in terms of healthcare assistance than rush/ultra-rush protocols,” the authors of the study wrote.

SOURCE:

Francesco Catamerò, MD, with the University of Florence, Florence, Italy, was the corresponding author of the study, which was published online on September 1 in Pediatric Allergy and Immunology.

LIMITATIONS:

The study’s retrospective design and male-biased sample may have limited data quality and sex-based insights, and reliance on patients to identify sting species may have led to misclassification of venom types and affected evaluation of treatment efficacy.

DISCLOSURES:

Mattia Giovannini reported receiving personal fees from Sanofi and Thermo Fisher Scientific.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.