Allergy Unit, Azienda Ospedale Università di Verona, Verona, Italy.
Allergy Unit, Hospital Universitario de Fuenlabrada, Madrid, Spain.
J Allergy Clin Immunol Pract. 2013 Sep-Oct;1(5):474-8. doi: 10.1016/j.jaip.2013.06.014. Epub 2013 Aug 30.
A preferential association between systemic mastocytosis (SM) and hymenoptera allergy (HVA) has been observed. Patients with both diseases are at risk for more severe reactions, and venom immunotherapy (VIT) may represent a life-saving treatment, but the use of VIT in such patients raised concerns about its safety.
We evaluated a large population of patients with SM and HVA who received VIT.
This prospective study was performed in Italy and Spain. A diagnosis of SM and HVA and a VIT prescription were made according to international recommendations. The patients were carefully followed up during VIT, with special attention to field stings.
A total of 84 patients (70 men, 14 women; mean age 52.1 years) were included, 81% with grade IV reaction, 91% with indolent SM. No difference was seen between the Italian and Spanish patients. There were 10 adverse reactions during the induction phase: 3 with the conventional induction and 7 with the rush-modified induction, none resulted in epinephrine administration and/or hospitalization. Fifty patients had one or more field re-sting (95 episodes), none during induction. The time elapsed from starting VIT and first re-sting was 2 months to 7 years, and the number of re-stings per patient was 1-6. Of the 50 patients who were re-stung, 43 (86%) resulted in being fully protected. Seven patients had reactions, and the maintenance dose was safely increased to 200 mcg. The maintenance dose interval was not different between patients with and those without reactions at re-stings.
VIT is well tolerated, safe, and effective in patients with SM.
已经观察到系统性肥大细胞增多症 (SM) 和膜翅目过敏症 (HVA) 之间存在优先关联。患有这两种疾病的患者有发生更严重反应的风险，而毒液免疫疗法 (VIT) 可能是一种救命的治疗方法，但在这些患者中使用 VIT 引起了对其安全性的担忧。
我们评估了接受 VIT 的大量患有 SM 和 HVA 的患者。
这项前瞻性研究在意大利和西班牙进行。根据国际建议，做出了 SM 和 HVA 的诊断和 VIT 处方。在 VIT 期间对患者进行了仔细的随访，特别注意实地蜇伤。
共纳入 84 例患者（70 名男性，14 名女性；平均年龄 52.1 岁），81%为 4 级反应，91%为惰性 SM。意大利和西班牙患者之间没有差异。在诱导期有 10 例不良反应：3 例为常规诱导，7 例为 rush 改良诱导，均未导致肾上腺素治疗和/或住院治疗。50 例患者中有 1 次或多次实地再蜇伤（95 例），均不在诱导期。从开始 VIT 到首次再蜇伤的时间为 2 个月至 7 年，每位患者的再蜇伤次数为 1-6 次。在接受再蜇伤的 50 例患者中，43 例（86%）得到完全保护。7 例患者出现反应，并安全地将维持剂量增加到 200 mcg。有反应和无反应的患者的维持剂量间隔没有差异。
VIT 在 SM 患者中耐受良好、安全且有效。
