Background:

Hymenoptera venom immunotherapy (VIT) is effective in preventing severe reactions to insect bites. Different protocols exist, being ultra-rush (UR) the fastest. However, doubts remain about its safety and risk factors involved in adverse reactions (AR).

Objective:

To evaluate the safety and risk factors for AR to VIT using the UR protocol.

Methods:

Retrospective analysis of patients treated with VIT according to UR protocol for bee, wasp, polistes (2010-2019). Safety and risk factors for AR were assessed.

Results:

Eighty-two patients were included: 77% men, median age 46 years (8-76). During the build-up phase, systemic AR occurred in 13% of patients (n = 11), 91% with VIT to bee. Systemic AR were mild in 36%, moderate in 64%. In 3 of these patients, pretreatment with Omalizumab was started, with subsequente tolerance of the protocol. Large local AR occurred in 17% of patients. There was an association between VIT to bee and the occurrence of systemic AR (p=0.003). Specific IgE to bee was significantly higher in the group of patients with systemic AR (p=0.027). There was no association with sex, initial reaction to the bite, atopy, use of ACE inhibitors or β-blockers. There was no statistically significant difference with age, total IgE, other specific IgE, basal tryptase, or concentration of the positive skin tests.

Conclusion:

Systemic AR during the build-up phase were mainly local and/or systemic mild / moderate, with good response to the treatment instituted. Pretreatment with Omalizumab was effective in patients with severe systemic AR, allowing the maintenance dose to be tolerated, without major complications. VIT to bee and higher levels of bee specific IgE are related to systemic RA. In these contexts, the risk should be weighted, and pre-treatment with Omalizumab may be considered.

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