Randolph C C, Reisman R E
J Allergy Clin Immunol. 1986 Jun;77(6):823-7. doi: 10.1016/0091-6749(86)90379-9.
During a 7-year period, venom immunotherapy has been stopped in 57 patients because of a fall in IgE antibody titers to insignificant levels (RAST less than 10% STD). All patients had a history of venom anaphylaxis and elevated venom-specific IgE before therapy. Maintenance doses of 50 micrograms were administered every 4 to 6 weeks; 30 patients received yellow jacket venom, and 16 patients received honeybee venom only. Therapy was stopped after treatment from 1 to 8 years (mean 2.8 years). Repeat skin tests demonstrated an average two-log decrease in sensitivity; 35 of 55 tests remained positive at venom concentrations of less than or equal to 0.1 micrograms/ml. There were 55 re-stings in 24 patients, occurring from 3 months to 5 years after cessation of therapy, resulting in three systemic reactions. One patient, previously treated with bee venom, reacted to a yellow jacket sting. These re-sting reactors also had tolerated several other stings after therapy was stopped. Thus, the two actual reactions represent a "failure" rate of 8% per patient and 4% per sting, compared to reaction rates of 27% and 17% in patients who stopped therapy without physician advice. These data suggest that this criterion may be reliable for stopping therapy. However, subsequent tolerated re-stings may require continued patient evaluation.
在7年期间，57例患者因IgE抗体滴度降至无显著意义的水平（放射性变应原吸附试验小于10%标准差）而停止毒液免疫疗法。所有患者在治疗前均有毒液过敏史且毒液特异性IgE升高。每4至6周给予50微克的维持剂量；30例患者接受黄蜂毒液治疗，16例患者仅接受蜜蜂毒液治疗。治疗1至8年后（平均2.8年）停止治疗。重复皮肤试验显示敏感性平均下降两个对数；55次试验中有35次在毒液浓度小于或等于0.1微克/毫升时仍为阳性。24例患者发生了55次再次蜇伤，在停止治疗后3个月至5年发生，导致3次全身反应。1例曾接受蜜蜂毒液治疗的患者对黄蜂蜇伤有反应。这些再次蜇伤反应者在停止治疗后也耐受了其他几次蜇伤。因此，与未经医生建议而停止治疗的患者27%和17%的反应率相比，这两次实际反应代表每位患者的“失败”率为8%，每次蜇伤的“失败”率为4%。这些数据表明该标准可能对停止治疗是可靠的。然而，随后耐受的再次蜇伤可能需要持续对患者进行评估。
