Blaauw P J, Smithuis O L, Elbers A R
Elkerliek Hospital, Helmond, The Netherlands.
J Allergy Clin Immunol. 1996 Jul;98(1):39-47. doi: 10.1016/s0091-6749(96)70224-5.
Venom immunotherapy is a generally accepted treatment for serious allergy to bee and yellow jacket venom. However, it is not precisely known to whom venom immunotherapy should be offered.
The purpose of this study was to determine whether an in-hospital insect sting challenge (IHC) can be used as a criterion for application or omission of venom immunotherapy.
An IHC was carried out in a group of 479 patients (136 sensitized to bee venom and 343 sensitized to yellow jacket venom). The patients with a negative IHC response were interviewed about their experience with subsequent stings under natural circumstances.
A total of 76 of 136 bee-sensitized patients (56%) and 284 of 343 yellow jacket-sensitized patients (83%) had a negative IHC response. All of the patients who had a systemic reaction after the IHC were advised to receive venom immunotherapy. The success rate of this therapy was 96.4% for patients allergic to bee venom (54 of 56) and 91.4% for patients allergic to yellow jacket venom (53 of 58). Of a total of 76 bee-sensitized patients with negative IHC responses, 41 were subsequently stung in the field; six patients had a mild (Mueller grade I) systemic reaction (14.6%). Of a total of 284 yellow jacket-sensitized with negative IHC responses, 127 were subsequently stung in the field; nine patients had a mild (Mueller grades I and II) systemic reaction (7.1%), and four patients had a severe (Mueller grades III and IV) systemic reaction (3.1%). Without an IHC as a selection criterion for venom immunotherapy, the percentage of patients unnecessarily treated was calculated to be 48% for bee venom-sensitized patients and 74% for yellow jacket-sensitized patients. However, with a negative test IHC response as a selection criterion for the omission of venom immunotherapy, 14.6% of the bee venom-sensitized patients and 10.2% of the yellow jacket-sensitized patients were proven to be at risk for systemic reactions on subsequent field stings.
Venom immunotherapy with bee or yellow jacket venom is justifiable only after a positive response to an IHC is observed.
毒液免疫疗法是治疗蜜蜂和黄蜂毒液严重过敏的一种普遍接受的方法。然而，对于哪些人应该接受毒液免疫疗法尚不清楚。
本研究的目的是确定住院昆虫叮咬激发试验（IHC）是否可作为应用或不应用毒液免疫疗法的标准。
对479例患者（136例对蜜蜂毒液致敏，343例对黄蜂毒液致敏）进行了IHC。对IHC反应阴性的患者询问其在自然环境中后续被叮咬的经历。
136例蜜蜂致敏患者中有76例（56%）、343例黄蜂致敏患者中有284例（83%）的IHC反应为阴性。所有在IHC后出现全身反应的患者均被建议接受毒液免疫疗法。该疗法对蜜蜂毒液过敏患者的成功率为96.4%（56例中的54例），对黄蜂毒液过敏患者的成功率为91.4%（58例中的53例）。在76例IHC反应阴性的蜜蜂致敏患者中，41例随后在野外被叮咬；6例患者出现轻度（米勒一级）全身反应（14.6%）。在284例IHC反应阴性的黄蜂致敏患者中，127例随后在野外被叮咬；9例患者出现轻度（米勒一级和二级）全身反应（7.1%），4例患者出现重度（米勒三级和四级）全身反应（3.1%）。若不以IHC作为毒液免疫疗法的选择标准，据计算，蜜蜂毒液致敏患者不必要接受治疗的比例为48%，黄蜂毒液致敏患者为74%。然而，若以IHC反应阴性作为不进行毒液免疫疗法的选择标准，14.6%的蜜蜂毒液致敏患者和10.2%的黄蜂毒液致敏患者被证明在后续野外被叮咬时有发生全身反应的风险。
只有在观察到IHC呈阳性反应后，用蜜蜂或黄蜂毒液进行毒液免疫疗法才是合理的。
