Predictors of side effects during the buildup phase of venom immunotherapy for Hymenoptera venom allergy: The importance of baseline serum tryptase

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:126

Article

Rueff, Franziska¹  Bilo, Maria Beatrice³  Mueller, Ulrich⁴  Scheipl, Fabian²  Aberer, Werner⁵  Birnbaum, Joelle⁶  Bodzenta-Lukaszyk, Anna⁷  Bonifazi, Floriano³  Campi, Paolo⁹  Darsow, Ulf^10,11,12  Egger, Cornelia¹³  Haeberli, Gabrielle⁴  Hawranek, Thomas¹⁴  Kucharewicz, Iwona⁷  Kuechenhoff, Helmut²  Lang, Roland¹⁴  Quercia, Oliviero¹⁵  Reider, Norbert¹³  Severino, Maurizio¹⁴  Sticherling, Michael¹⁶  Sturm, Gunter Johannes⁵  Wuethrich, Brunello⁸ 

[1] Univ Munich, AllergieZentrum, Klin & Poliklin Dermatol & Allergol, Dept Dermatol & Allergol, D-80337 Munich, Germany

[2] Univ Munich, Dept Stat, Stat Consulting Unit, D-80337 Munich, Germany

[3] Azienda Osped Univ, Osped Riuniti Ancona, Dept Internal Med Allergy Immunol & Resp Dis, Allergy Unit, Ancona, Italy

[4] Spitalnetz Bern, Spital Ziegler, Allergiestn Med Klin, Bern, Switzerland

[5] Med Univ Graz, Dept Dermatol, Graz, Austria

[6] Hop St Marguerite, Serv Pneumoallergol, Marseille, France

[7] Med Univ Bialystok, Dept Allergol & Internal Med, Bialystok, Poland

[8] Univ Spital Zurich, Dermatol Klin & Poliklin, Zurich, Switzerland

[9] Nuovo Osped San Giovanni Dio, Allergy Clin, Florence, Italy

[10] Tech Univ Munich, Dept Dermatol & Allergy Biederstein, Munich, Germany

[11] Tech Univ Munich, Div Environm Dermatol, Munich, Germany

[12] Tech Univ Munich, Allergy Helmholtz Ctr, Munich, Germany

[13] Med Univ Innsbruck, Dept Dermatol, Innsbruck, Austria

[14] Paracelsus Private Med Univ, Dept Dermatol, Salzburg, Austria

[15] Osped Infermi, Dipartimento Med Interna, Faenza, Italy

[16] Univ Klinikum Erlangen, Hautklin, Erlangen, Germany

关键词: Hymenoptera venom;    allergy;    venom immunotherapy;    tryptase;    risk factors;    ACE inhibitor;    age;    sex;   

DOI  :  10.1016/j.jaci.2010.04.025

来源: Elsevier

【 摘 要 】

Background: Severe side effects during venom immunotherapy (VIT) are 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, which are routinely recorded during patient evaluation, with the frequency of severe reactions requiring an emergency intervention during the buildup phase of VIT. Methods: In this observational prospective multicenter study, we enrolled 680 patients with established honeybee or vespid venom allergy who underwent VIT. Data were collected on tryptase concentration, age, sex, culprit insect, cardiovascular medication, degree of preceding sting reaction, preventive antiallergic medication before therapy, time between last preceding sting reaction and VIT, venom specific IgE concentration, and type of buildup procedure. Relative rates were calculated with generalized additive models. Results: Fifty-seven patients (8.4%) required an emergency intervention during buildup because of a severe systemic reaction. The frequency of interventions increased significantly with higher BTC (log-linear association; adjusted odds ratio, 1.56; 95% CI, 1.15-2.11; P<.005). The predictive power of BTC was markedly greater when VIT was performed for vespid venom allergy than for bee venom (for bee VIT, no significant association; for vespid VII, log-linear association; adjusted odds ratio, 2.33; 95% CI, 1.28-4.26; P = .005). The most important other factor significantly associated with severe reactions during the buildup phase of VII was bee venom allergy. Conclusion: Before vespid VIT, measurement of baseline serum tryptase concentration should be used to identify patients with a high risk for side effects. Patients with bee venom allergy require a particularly high degree of surveillance during VIT. (J Allergy Clin Immunol 2010;126:105-11.)

【 授权许可】

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