A simple 3-day “rush” venom immunotherapy protocol: documentation of safety

BackgroundVenom immunotherapy (VIT) is the only effective treatment for hymenoptera hypersensitivity, but conventional protocols require a few weeks.ObjectiveWe present the safety of a 3-day “rush” protocol that requires only 7 injections and 255 mgr cumulative dose before the 100 μg maintenance dose.MethodsForty-nine patients (33 males, 16 females) of mean age 43.57±12.9yrs received “rush” VIT. Only 7 injections were required until the maintenance dose of 100 mgr was reached on Day 5. On Day 1, four injections were administered with initial dose of 5 mgr and total dose of 75 μg. On Day 3 a cumulative dose of 180 mgr was administered in three injections (40 mgr, 60 mgr and 80 mgr). A dose of 100 mgr was administered on Day 5. Twenty-nine individuals were treated with Honey-Bee venom; 18 with Common wasp; 5 with Paper Wasp; while 13 patients received Mixed Vespid preparation. Inclusion criteria were documented IgE-mediated allergy with intradermal sensitivity to ≤0.1 mgr/ml venom concentration and concomitant detection of specific venom IgE ≥0.35 kU/l.ResultsAll patients reached the maintenance dose. Forty-nine patients received 65 immunotherapy courses, resulting in 1520 injections. Thirty-three systemic reactions: 7 during building phase (1.5%); and 26 in the maintenance dose (2.4%) were observed in 9 patients. The percentage of reactions/total injection number was 2.2%; all reactions were mild-to-moderate. Fourteen patients reported documented field stings at least two months after VIT onset with only one reported mild systemic reaction.ConclusionWe propose a simple “rush” VIT protocol in an outpatient setting as an easy-to-perform alternative option for VIT induction phase.