A 13-year real-life study on efficacy, safety and biological effects of venom immunotherapy.

BACKGROUND

venom immunotherapy (VIT) is a clinically effective treatment. However, little is known about its long-term clinical efficacy and biological effects. Several mechanisms have been proposed to account for VIT efficacy, including reduction of specific IgE and induction of allergen-specific IgG, but the overall picture remains elusive. We investigated VIT clinical efficacy up to 8 years after discontinuation and the kinetics of -specific IgE and IgG. Out of 686 consecutive patients we retrospectively selected and analysed a series of 23 patients with allergy that underwent a 5-year IT course, followed by a prolonged follow-up.

METHODS

Clinical efficacy of VIT was assessed as number and severity of reactions to re-stinging events. The presence of -specific IgE and IgG was also monitored over time.

RESULTS

During the VIT treatment, patients were protected, reporting no reactions or mild reactions in occasion of re-stinging events. This protection was entirely maintained during the follow-up, up to 8 years. Skin reactivity (reflecting mast cell-bound -specific IgE) and circulating -specific IgE levels declined substantially during VIT. Notably, this reduction was maintained over time during the follow-up. Moreover, all the patients were analysed for IgG. A robust induction of -specific IgG was observed during the VIT course, with a substantial decline during the follow-up.

CONCLUSIONS

We conclude that VIT is a clinically effective treatment, which induces long-term protection after discontinuation. The reduction of specific IgE, assessed by skin tests and RAST, closely matches the VIT- induced protection, while the IgG induction seems not to be associated with VIT clinical efficacy in the long term.