F Ruëff1, B Przybilla. 1. Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, Frauenlobstr. 9-11, 80337, München, Deutschland, Franziska.Rueff@med.uni-muenchen.de.
Abstract
BACKGROUND: Venom immunotherapy (VIT) is a highly effective treatment for Hymenoptera venom allergy. However, VIT treatment may fail to protect against systemic reactions. Many in vitro parameters as well as skin test reactivity change during the course of VIT; however, similar to the pre-treatment situation, there is no in vitro parameter, which reliably indicates the clinical reactivity of a sensitized patient. Sting challenge with the culprit insect is the only tool which reveals clinical reactivity. OBJECTIVES: To define the indications, contraindications and performance of sting challenge tests. MATERIAL AND METHODS: Review of the literature. RESULTS: Sting challenge tests are not recommended for individuals who are not being treated with VIT, and are also not recommended as a routine diagnostic method for patients who have stopped VIT. Indications of sting challenge are identification of patients who are not protected, and quality of life issues. Major contraindications of sting challenge are repeated side effects or a field sting reaction during maintenance VIT, and unstable medical disease. Risk factors for treatment failure are mastocytosis, bee venom allergy, repeated side effects of VIT, and ACE inhibitors. Protection rate is significantly better in patients who are treated with elevated venom dose, with double VIT, and longer treatment duration. CONCLUSIONS: For the majority of patients quality of life will significantly improve after tolerated sting challenge. A sting challenge test is particularly important in those patients who are at increased risk due their increased risk of treatment failure. If in patients with risk factors for treatment failure, VIT is done with elevated dose or if no risk factors are present, a sting challenge may not be needed. VIT with an elevated dose may prevent or correct treatment failure.
BACKGROUND: Venom immunotherapy (VIT) is a highly effective treatment for Hymenoptera venom allergy. However, VIT treatment may fail to protect against systemic reactions. Many in vitro parameters as well as skin test reactivity change during the course of VIT; however, similar to the pre-treatment situation, there is no in vitro parameter, which reliably indicates the clinical reactivity of a sensitized patient. Sting challenge with the culprit insect is the only tool which reveals clinical reactivity. OBJECTIVES: To define the indications, contraindications and performance of sting challenge tests. MATERIAL AND METHODS: Review of the literature. RESULTS: Sting challenge tests are not recommended for individuals who are not being treated with VIT, and are also not recommended as a routine diagnostic method for patients who have stopped VIT. Indications of sting challenge are identification of patients who are not protected, and quality of life issues. Major contraindications of sting challenge are repeated side effects or a field sting reaction during maintenance VIT, and unstable medical disease. Risk factors for treatment failure are mastocytosis, bee venom allergy, repeated side effects of VIT, and ACE inhibitors. Protection rate is significantly better in patients who are treated with elevated venom dose, with double VIT, and longer treatment duration. CONCLUSIONS: For the majority of patients quality of life will significantly improve after tolerated sting challenge. A sting challenge test is particularly important in those patients who are at increased risk due their increased risk of treatment failure. If in patients with risk factors for treatment failure, VIT is done with elevated dose or if no risk factors are present, a sting challenge may not be needed. VIT with an elevated dose may prevent or correct treatment failure.
Authors: F Ruëff; B Vos; J Oude Elberink; A Bender; R Chatelain; S Dugas-Breit; H-P Horny; H Küchenhoff; A Linhardt; S Mastnik; K Sotlar; E Stretz; R Vollrath; B Przybilla; M Flaig Journal: Clin Exp Allergy Date: 2014 Impact factor: 5.018
Authors: Rui S Ferreira Junior; Juliana M Sciani; Rafael Marques-Porto; Airton Lourenço Junior; Ricardo de O Orsi; Benedito Barraviera; Daniel C Pimenta Journal: Toxicon Date: 2010-04-18 Impact factor: 3.033
Authors: Robert J Boyle; Mariam Elremeli; Juliet Hockenhull; Mary Gemma Cherry; Max K Bulsara; Michael Daniels; J N G Oude Elberink Journal: Cochrane Database Syst Rev Date: 2012-10-17
Authors: Franziska Ruëff; Bernhard Przybilla; Maria Beatrice Biló; Ulrich Müller; Fabian Scheipl; Michael J Seitz; Werner Aberer; Anna Bodzenta-Lukaszyk; Floriano Bonifazi; Paolo Campi; Ulf Darsow; Gabrielle Haeberli; Thomas Hawranek; Helmut Küchenhoff; Roland Lang; Oliviero Quercia; Norbert Reider; Peter Schmid-Grendelmeier; Maurizio Severino; Gunter Johannes Sturm; Regina Treudler; Brunello Wüthrich Journal: PLoS One Date: 2013-05-20 Impact factor: 3.240
Authors: Tamara Eitel; Kim Nikola Zeiner; Katharina Assmus; Hanns Ackermann; Nadja Zoeller; Markus Meissner; Roland Kaufmann; Stefan Kippenberger; Eva Maria Valesky Journal: World Allergy Organ J Date: 2021-04-21 Impact factor: 4.084