Department of Dermatology and Allergology, Ludwig-Maximilians-Universität, München, Germany.
PLoS One. 2013 May 20;8(5):e63233. doi: 10.1371/journal.pone.0063233. Print 2013.
Treatment failure during venom immunotherapy (VIT) may be associated with a variety of risk factors.
Our aim was to evaluate the association of baseline serum tryptase concentration (BTC) and of other parameters with the frequency of VIT failure during the maintenance phase.
In this observational prospective multicenter study, we followed 357 patients with established honey bee or vespid venom allergy after the maintenance dose of VIT had been reached. In all patients, VIT effectiveness was either verified by sting challenge (n = 154) or patient self-reporting of the outcome of a field sting (n = 203). Data were collected on BTC, age, gender, preventive use of anti-allergic drugs (oral antihistamines and/or corticosteroids) right after a field sting, venom dose, antihypertensive medication, type of venom, side effects during VIT, severity of index sting reaction preceding VIT, and duration of VIT. Relative rates were calculated with generalized additive models.
22 patients (6.2%) developed generalized symptoms during sting challenge or after a field sting. A strong association between the frequency of VIT failure and BTC could be excluded. Due to wide confidence bands, however, weaker effects (odds ratios <3) of BTC were still possible, and were also suggested by a selective analysis of patients who had a sting challenge. The most important factor associated with VIT failure was a honey bee venom allergy. Preventive use of anti-allergic drugs may be associated with a higher protection rate.
It is unlikely that an elevated BTC has a strong negative effect on the rate of treatment failures. The magnitude of the latter, however, may depend on the method of effectiveness assessment. Failure rate is higher in patients suffering from bee venom allergy.
在变应原免疫治疗（VIT）过程中治疗失败可能与多种危险因素相关。
我们旨在评估基线血清类胰蛋白酶浓度（BTC）和其他参数与维持阶段 VIT 失败频率的相关性。
在这项观察性前瞻性多中心研究中，我们对 357 例已确立的蜜蜂或胡蜂毒液过敏患者进行了随访，这些患者已达到 VIT 的维持剂量。在所有患者中，通过蜇伤挑战（n=154）或患者自我报告实地蜇伤的结果（n=203）验证了 VIT 的有效性。收集 BTC、年龄、性别、实地蜇伤后立即预防性使用抗变态反应药物（口服抗组胺药和/或皮质类固醇）、毒液剂量、抗高血压药物、毒液类型、VIT 期间的副作用、VIT 前索引蜇伤反应的严重程度和 VIT 持续时间的数据。使用广义加性模型计算相对率。
22 例患者（6.2%）在蜇伤挑战或实地蜇伤后出现全身症状。VIT 失败频率与 BTC 之间存在很强的关联，可以排除。然而，由于置信区间较宽，BTC 的较弱影响（比值比<3）仍然可能存在，对接受蜇伤挑战的患者进行选择性分析也提示了这一点。与 VIT 失败最相关的因素是蜜蜂毒液过敏。预防性使用抗变态反应药物可能与更高的保护率相关。
BTC 升高不太可能对治疗失败率产生强烈的负面影响。然而，后者的幅度可能取决于有效性评估的方法。患有蜂毒液过敏的患者失败率更高。
