Ruëff F, Kroth J, Przybilla B
AllergieZentrum, Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, Munich, Germany.
Allergol Select. 2017 Aug 4;1(1):53-58. doi: 10.5414/ALX01320E. eCollection 2017.
. Risk factors should be part of the decision, of which patient should be offered venom immunotherapy (VIT) and how VIT should be performed. Risk factors for a severe systemic anaphylactic reaction (SAR) after a Hymenoptera field sting include a preceding less severe sting reaction, a wasp sting, an increased baseline serum tryptase concentration (BSTC), mastocytosis, older age, ACE inhibitor medication, and male gender. During VIT, treatment with honey bee venom is the most important risk factor for a SAR. Further risk factors include a high BSTC (for vespid VIT only), presence of venom specific IgE in serum, any antihypertensive medication during therapy, and an ultra-rush protocol for build-up. Treatment failure is more common in patients suffering from honey bee venom allergy, high BSTC (for vespid VIT only) or mastocytosis, and in those who had experienced side effects during VIT. Besides discontinuing antihypertensive medication or switching to a moderate type of dose increase during build-up, little can be done to minimize the risks associated with VIT. Increasing the maintenance dose may improve the efficacy of VIT. In patients with a particularly high risk for treatment failure, or in case of treatment failure, VIT should include an increased maintenance dose right from the beginning. Usually, 200 µg will be sufficient.
风险因素应成为决策的一部分，即哪些患者应接受毒液免疫疗法（VIT）以及应如何实施VIT。膜翅目昆虫野外蜇伤后发生严重全身过敏反应（SAR）的风险因素包括先前较轻的蜇伤反应、黄蜂蜇伤、基线血清类胰蛋白酶浓度（BSTC）升高、肥大细胞增多症、年龄较大、服用血管紧张素转换酶抑制剂药物以及男性。在VIT期间，用蜜蜂毒液治疗是发生SAR的最重要风险因素。其他风险因素包括高BSTC（仅适用于黄蜂VIT）、血清中存在毒液特异性IgE、治疗期间使用任何抗高血压药物以及采用超快速递增方案。治疗失败在蜜蜂毒液过敏患者、高BSTC（仅适用于黄蜂VIT）或肥大细胞增多症患者以及在VIT期间出现副作用的患者中更为常见。除了停用抗高血压药物或在递增期间改用中等剂量增加方式外，几乎无法采取措施将与VIT相关的风险降至最低。增加维持剂量可能会提高VIT的疗效。对于治疗失败风险特别高的患者，或在治疗失败的情况下，VIT应从一开始就包括增加维持剂量。通常，200μg就足够了。
