Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy; Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Ancona, Italy.
Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Ancona, Italy.
J Allergy Clin Immunol Pract. 2021 Feb;9(2):702-708. doi: 10.1016/j.jaip.2020.11.030. Epub 2020 Nov 26.
According to expert consensus, the time interval between Hymenoptera venom immunotherapy (VIT) injections can be extended up to 12 weeks, without significant impact on efficacy and safety. However, the coronavirus disease 2019 pandemic caused longer delays, and no recommendations are available to manage this huge extension.
To provide advice on how to resume VIT safely after a long delay from the last injection considering the potential risk factors for side effects, without starting again with the induction phase.
All the patients who delayed VIT because of the pandemic were consecutively enrolled in this single-center study. The time extension was decided according to their risk profile (eg, long prepandemic time interval, severe pre-VIT reaction, older age, multitreatments), and correlation analyses were performed to find potential risk factors of side effects.
The mean delay from the pre- (7 weeks) to the postpandemic VIT interval (15.5 weeks) was 8.5 weeks. The total amount of the prepandemic VIT maintenance dose was safely administered in 1 day in 78% of patients, whereas only 3, of 87, experienced side effects, and their potential risk factors were identified in bee venom allergy and recent VIT initiation.
In a real-world setting, long VIT delays may be safe and well tolerated, but more caution should be paid in resuming VIT in patients with long prepandemic maintenance interval, severe pre-VIT reaction, recent VIT initiation, older age, multidrug treatments, and bee venom allergy. This is useful in any case of long, unplanned, and unavoidable VIT delay.
根据专家共识，在不影响疗效和安全性的情况下，蜂疗免疫治疗（VIT）的注射间隔时间可延长至 12 周。然而，由于 2019 年冠状病毒病大流行，导致间隔时间延长，目前尚无管理这种巨大延长的建议。
提供在最后一次注射后因长时间延迟而重新开始 VIT 的建议，考虑到潜在的副作用风险因素，而无需再次开始诱导期。
本研究为单中心研究，连续纳入所有因大流行而延迟 VIT 的患者。根据他们的风险状况（例如，长流行前时间间隔、严重 VIT 前反应、年龄较大、多治疗）来决定时间延长，进行相关性分析以找到副作用的潜在风险因素。
从流行前（7 周）到流行后 VIT 间隔（15.5 周）的平均延迟为 8.5 周。在 78%的患者中，流行前 VIT 维持剂量的总量可在 1 天内安全给药，而只有 87 例中的 3 例出现副作用，其潜在风险因素在蜂毒过敏和最近开始 VIT 中被发现。
在真实环境中，长时间的 VIT 延迟可能是安全且耐受良好的，但在重新开始 VIT 时应更加谨慎，特别是在具有长流行前维持间隔、严重 VIT 前反应、最近开始 VIT、年龄较大、多药物治疗和蜂毒过敏的患者中。在任何情况下，这对于计划外和不可避免的长时间 VIT 延迟都很有用。
