A recent study has confirmed the safety and efficacy of subcutaneous venom immunotherapy (VIT) for children suffering from allergies to Hymenoptera venom. Conducted by a team led by Mattia Giovannini from the University of Florence and the allergy unit at Meyer Children’s Hospital IRCCS in Florence, Italy, the research indicates that VIT could be a vital treatment option for pediatric patients with a history of severe allergic reactions to insect stings.
The findings, published in the journal Pediatr Allergy Immunol, reveal that the cluster protocol used in VIT resulted in a low systemic reaction rate of only 0.4% among the total doses administered. Notably, none of the patients required epinephrine during the study period.
Study Overview and Methodology
The study aimed to evaluate the safety and efficacy of VIT while also identifying factors associated with adverse reactions. Researchers analyzed the medical records of 58 patients under 18 years old who received VIT between 1997 and 2021. The cohort was predominantly male, with 87.9% of participants, and had a median age of 9.4 years.
During the study, the VIT protocol included a median treatment duration of 5.4 years and an average of 63.4 injections per patient. Family history of atopy was noted in 47.7% of the cases, with some participants exhibiting additional atopic symptoms such as rhinoconjunctivitis and asthma.
The researchers followed guidelines set by the European Academy of Allergy and Clinical Immunology and the Italian Consensus on Hymenoptera venom allergy management when selecting the VIT extracts. The study examined four types of venom: Apis mellifera, Vespula, Polistes, and Vespa crabro.
Adverse Reactions and Treatment Efficacy
Throughout the administration of 3739 injections, a total of 335 adverse reactions were reported, translating to a 9.5% reaction rate. The majority of these reactions were classified as local (8.2%) or extended local (0.9%), while systemic reactions accounted for 0.4% of cases.
The build-up phase of VIT was associated with a higher frequency of adverse reactions, with 194 reactions reported during 1120 injections. In contrast, the maintenance phase involved 2619 injections with only 161 adverse events. There were no statistically significant differences in the occurrence of extended local or systemic reactions between the two phases.
The research also found that systemic reactions were most prevalent in patients treated with Polistes venom, which had a rate of 0.5%. Despite the occurrence of adverse reactions, VIT was shown to be effective in managing venom allergies. Among patients who experienced re-stings, only 2 (3.9%) reported systemic reactions, which were linked to different Hymenoptera species than that targeted during VIT.
The study concluded that the cluster protocol for VIT is both safe and effective for pediatric patients. It highlighted that while the build-up phase is associated with a higher rate of adverse reactions, other factors such as sex, age, and type of venom extract did not significantly influence the risk of adverse events.
The research underscores the importance of VIT as a proven treatment for patients with venom allergies, providing a valuable option for those at risk of severe allergic reactions.
