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Treatment of Hymenoptera venom allergy: an update

Pesek, Robbie D.; Lockey, Richard F.

Current Opinion in Allergy and Clinical Immunology: August 2014 - Volume 14 - Issue 4 - p 340–346
doi: 10.1097/ACI.0000000000000073
ANAPHYLAXIS AND INSECT ALLERGY: Edited by Jeffrey G. Demain and Gianenrico Senna

Purpose of review To review and summarize the studies published between 2012 and 2014 about the use of venom immunotherapy (VIT) to treat Hymenoptera hypersensitivity.

Recent findings Several studies reconfirm the effectiveness of VIT in both children and adults, and provide a better understanding of its immune-modulating effects. There are concerns about its cost-effectiveness; however, VIT versus self-injectable epinephrine alone when stung is the preferred treatment of choice for affected individuals when quality-of-life issues are considered. Ultrarush VIT may be as effective in children as in adults but is associated with a high risk of systemic allergic reactions (SARs). Controversy continues about the use of angiotensin-converting enzyme inhibitors and their potential for increased SARs while on VIT. Individuals with mast cell disorders, female sex, honeybee allergy, and those receiving rush or ultrarush VITs are at higher risk for SARs. Elevated baseline serum tryptase levels greater than 20 μg/l, SARs during VIT, and honeybee sensitivity are risk factors for VIT failure.

Summary VIT remains the gold standard to treat Hymenoptera-allergic individuals to prevent future sting-induced SARs in both children and adults.

aArkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas

bUSF Morsani College of Medicine and the James A. Haley Veteran's Hospital, Tampa, Florida, USA

Correspondence to Robbie D. Pesek, 13 Children's Way, Slot 512-12, Little Rock, AR 72202, USA. Tel: +1 501 364 1060; fax: +1 501 364 3173; e-mail:

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