Haye Rolf, Døsen Liv Kari
Department of Otolaryngology, Rikshospitalet-Radiumhospitalet HF, University of Oslo, 0027 Oslo, Norway.
Clin Mol Allergy. 2005 Aug 19;3:12. doi: 10.1186/1476-7961-3-12.
Previously we treated patients with insect sting allergy with venom immunotherapy (IT) using whole body insect extracts. From 1980 we changed to insect venoms. The purpose of this study was to analyse data from the patients in order to improve our treatment.
This is an open, single centre study on patients treated with venom IT 14 years or older with a history of a systemic allergic reaction to an insect sting, a positive skin prick test (SPT) or a positive RAST and willingness to comply with five years of IT. Clinical and laboratory data were registered prospectively at the start of IT and after five years of treatment until 2003 on patients who started IT between 1980 and 1998. Questionnaires were answered in 1989, 1993 and 2003. Statistical analysis was done with Pearson's chi square, Fisher's exact or the t-test.
Of 315 patients treated, 44 were given bee, 248 common wasp and 23 both venoms. Of the common wasp sting incidents 5.5 % resulted in a severe allergic reaction (SAR) during adequate IT and 22% after cessation. Seventy-one per cent of the patients carried epinephrine. Precautionary steps were taken by 77% of the patients during or after inadequate IT. On or after adequate IT 83% felt completely or substantially safe. Surprisingly 29 % of those inadequately treated felt safer and 50% were satisfied with having had the opportunity to be treated. The SPT became negative in 68% of the wasp allergic patients after five years of adequate IT. Increased risk of experiencing SAR to a future sting in wasp allergic patients after cessation of adequate IT was significantly associated with a SAR due to IT during the rush regimen. SAR due to IT occurred very rarely during maintenance dosing.
Adequate venom IT is very effective while ongoing but somewhat less effective after cessation, while inadequate treatment gives poor results. More of our patients should complete five years of IT and some should continue IT. The type of reaction to IT during incremental dosing may be of help in deciding who should continue beyond five years. Maintenance IT may be taken over by the general physician.
此前我们使用全虫提取物通过毒液免疫疗法（IT）治疗昆虫叮咬过敏患者。从1980年起我们改用昆虫毒液。本研究的目的是分析患者数据以改进我们的治疗方法。
这是一项开放的单中心研究，研究对象为14岁及以上接受毒液IT治疗的患者，这些患者有昆虫叮咬引起的全身过敏反应病史、皮肤点刺试验（SPT）阳性或放射性变应原吸附试验（RAST）阳性，且愿意接受为期五年的IT治疗。1980年至1998年开始接受IT治疗的患者，在IT开始时和治疗五年后直至2003年，前瞻性地记录临床和实验室数据。在1989年、1993年和2003年进行问卷调查。采用Pearson卡方检验、Fisher精确检验或t检验进行统计分析。
在接受治疗的315例患者中，44例接受蜜蜂毒液治疗，248例接受普通黄蜂毒液治疗，23例同时接受两种毒液治疗。在接受充分IT治疗期间，普通黄蜂叮咬事件中有5.5%导致严重过敏反应（SAR），停止治疗后为22%。71%的患者携带肾上腺素。77%的患者在IT治疗不足期间或之后采取了预防措施。在充分IT治疗期间或之后，83%的患者感到完全或基本安全。令人惊讶的是，29%治疗不足的患者感觉更安全，50%的患者对有机会接受治疗感到满意。经过五年充分的IT治疗后，68%的黄蜂过敏患者的SPT变为阴性。充分IT治疗停止后，黄蜂过敏患者未来再次被蜇时发生SAR的风险增加，这与快速注射方案期间IT引起的SAR显著相关。维持给药期间，IT引起的SAR非常罕见。
充分的毒液IT治疗在进行期间非常有效，但停止后效果稍差，而治疗不足则效果不佳。我们更多的患者应完成五年的IT治疗，部分患者应继续接受IT治疗。递增给药期间对IT的反应类型可能有助于决定哪些患者应在五年后继续治疗。维持性IT治疗可由普通医生接管。
