Stoevesandt Johanna, Hosp Christine, Kerstan Andreas, Trautmann Axel
Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.
Department of Dermatology and Allergy, University Hospital Würzburg, Würzburg, Germany.
Ann Allergy Asthma Immunol. 2015 May;114(5):411-6. doi: 10.1016/j.anai.2015.03.001.
The hypothetical risks of cardiovascular medication during Hymenoptera venom immunotherapy (VIT) are still a matter of controversy.
To assess the potential influence of β-blockers (BBs) and/or angiotensin-converting enzyme inhibitors (ACEIs) on the long-term safety and outcome of VIT.
Data on the course of VIT maintenance phase, Hymenoptera re-stings, and concurrent medication were retrospectively derived from standardized questionnaires in a cohort of patients with significant cardiovascular comorbidity.
Of 225 patients, 125 (55.6%) were taking cardiovascular medication at the time of data collection: 71 (31.6%) took an ACEI, and 40 (17.8%) took a BB. A total of 3,397 months of maintenance VIT during intake of an ACEI and 1,418 months during BB therapy were evaluated. Cumulative VIT-related reaction rates, including subjective symptoms, were 9.1% per treatment cycle and 0.31% per injection, with objective reaction rates of 1.7% and 0.06%, respectively. The incidence of adverse events was significantly higher in patients with a previous history of systemic reactions at VIT buildup (P = .004). Surprisingly, reaction rates were lower in patients taking any kind of cardiovascular medication (P = .04) or an ACEI (P = .03). The overall reexposure rate to Hymenoptera stings was 42.7%, and the field sting-induced objective reaction rate was 7.3%. There was no evidence of an increase of field sting-related relapse or hospitalization rates by concurrent cardiovascular medication.
Cardiovascular medication does not impair the safety and/or the efficacy of Hymenoptera VIT.
膜翅目昆虫毒液免疫疗法（VIT）期间使用心血管药物的潜在风险仍存在争议。
评估β受体阻滞剂（BBs）和/或血管紧张素转换酶抑制剂（ACEIs）对VIT长期安全性和疗效的潜在影响。
回顾性地从一组有显著心血管合并症患者的标准化问卷中获取VIT维持阶段病程、膜翅目昆虫再次蜇伤及同时使用药物的数据。
在225例患者中，125例（55.6%）在数据收集时正在服用心血管药物：71例（31.6%）服用ACEI，40例（17.8%）服用BB。共评估了服用ACEI期间3397个月的维持VIT和服用BB治疗期间1418个月的维持VIT。包括主观症状在内的VIT相关累积反应率为每个治疗周期9.1%，每次注射0.31%，客观反应率分别为1.7%和0.06%。VIT诱导期有全身反应既往史的患者不良事件发生率显著更高（P = .004）。令人惊讶的是，服用任何一种心血管药物（P = .04）或ACEI（P = .03）的患者反应率较低。膜翅目昆虫蜇伤的总体再次暴露率为42.7%，野外蜇伤引起的客观反应率为7.3%。没有证据表明同时使用心血管药物会增加野外蜇伤相关的复发率或住院率。
心血管药物不会损害膜翅目昆虫VIT的安全性和/或疗效。
