6 research outputs found
Clinical effectiveness of hymenoptera venom immunotherapy
Treatment failure during venom immunotherapy (VIT) may be associated with a variety of risk factors. Our aim was to evaluate the association of baseline serum tryptase concentration (BTC) and of other parameters with the frequency of VIT failure during the maintenance phase. In this observational prospective multicenter study, we followed 357 patients with established honey bee or vespid venom allergy after the maintenance dose of VIT had been reached. In all patients, VIT effectiveness was either verified by sting challenge (n = 154) or patient self-reporting of the outcome of a field sting (n = 203). Data were collected on BTC, age, gender, preventive use of anti-allergic drugs (oral antihistamines and/or corticosteroids) right after a field sting, venom dose, antihypertensive medication, type of venom, side effects during VIT, severity of index sting reaction preceding VIT, and duration of VIT. Relative rates were calculated with generalized additive models. 22 patients (6.2%) developed generalized symptoms during sting challenge or after a field sting. A strong association between the frequency of VIT failure and BTC could be excluded. Due to wide confidence bands, however, weaker effects (odds ratios <3) of BTC were still possible, and were also suggested by a selective analysis of patients who had a sting challenge. The most important factor associated with VIT failure was a honey bee venom allergy. Preventive use of anti-allergic drugs may be associated with a higher protection rate. It is unlikely that an elevated BTC has a strong negative effect on the rate of treatment failures. The magnitude of the latter, however, may depend on the method of effectiveness assessment. Failure rate is higher in patients suffering from bee venom allergy
Clinical effectiveness of hymenoptera venom immunotherapy: a prospective observational multicenter study of the European academy of allergology and clinical immunology interest group on insect venom hypersensitivity
BACKGROUND: Treatment failure during venom immunotherapy (VIT) may be associated with a variety of risk factors.
OBJECTIVE: Our aim was to evaluate the association of baseline serum tryptase concentration (BTC) and of other parameters with the frequency of VIT failure during the maintenance phase.
METHODS: In this observational prospective multicenter study, we followed 357 patients with established honey bee or vespid venom allergy after the maintenance dose of VIT had been reached. In all patients, VIT effectiveness was either verified by sting challenge (n = 154) or patient self-reporting of the outcome of a field sting (n = 203). Data were collected on BTC, age, gender, preventive use of anti-allergic drugs (oral antihistamines and/or corticosteroids) right after a field sting, venom dose, antihypertensive medication, type of venom, side effects during VIT, severity of index sting reaction preceding VIT, and duration of VIT. Relative rates were calculated with generalized additive models.
RESULTS: 22 patients (6.2%) developed generalized symptoms during sting challenge or after a field sting. A strong association between the frequency of VIT failure and BTC could be excluded. Due to wide confidence bands, however, weaker effects (odds ratios <3) of BTC were still possible, and were also suggested by a selective analysis of patients who had a sting challenge. The most important factor associated with VIT failure was a honey bee venom allergy. Preventive use of anti-allergic drugs may be associated with a higher protection rate.
INTERPRETATION: It is unlikely that an elevated BTC has a strong negative effect on the rate of treatment failures. The magnitude of the latter, however, may depend on the method of effectiveness assessment. Failure rate is higher in patients suffering from bee venom allergy
Distribution of therapy failures during the maintenance phase of VIT with respect to baseline parameters.
<p>Associations are shown between clinical, demographic and therapeutic parameters and the need for an emergency intervention during an in-hospital sting challenge or, after a field sting by the culprit insect, the development of any type of generalized symptom.</p
Smooth function and pointwise 95% confidence bands (dashed lines) for the effect of baseline tryptase concentration on the risk to need an emergency intervention during sting challenge or to develop generalized symptoms after a field sting (final multivariate generalized additive model).
<p>Odds ratios are referred to those of the median of tryptase concentration. The odds ratio of the latter has been set at 1.</p
Results of the final generalized additive model for the risk to need an emergency intervention during an in-hospital sting challenge or, after a field sting by the culprit insect, to develop any type of generalized symptom.
<p>Those variables are shown, which were selected according to the modeling procedure. P-values and widths of confidence intervals are biased downwards due to the effect of subset selection.</p
Receiver operating characteristic (ROC) curve for the final multiple logistic regression model predicting the risk to need an emergency intervention during sting challenge or to develop generalized symptoms after a field sting.
<p>Models were tested without including the effect of BTC, or with including a smoothed or a linear effect. Corresponding areas under the curve were 0.7449, 0.7084 or 0.7240.</p