A Controlled Trial of Immunotherapy in Insect Hypersensitivity

Insect hypersensitivity is currently treated by immunization using whole-body extracts. We compared this regimen with immunotherapy using insect venoms or placebo in groups of 20 patients matched for history and sensitivity, as judged by venom skin test, histamine release and IgE antibody to venom. After six to 10 weeks of immunization, systemic reactions to stings occurred in seven of 12, seven of 11, and one of 18 patients treated with placebo, whole-body extract, and venom, respectively. Placebo and whole-body extract gave similar results and were significantly less effective than venom immunotherapy (P<0.01). The 14 patients with failure of treatment with whole-body extract and placebo were subsequently provided with venom immunotherapy; one reacted to a subsequent sting. We conclude that venom immunotherapy is clinically superior to therapy on whole-body extract or placebo. (N Engl J Med 299:157–161, 1978) ANAPHYLAXIS after stings by insects of the order hymenoptera has been recorded since antiquity. The number of deaths annually attributable to this cause exceeds 50.¹ Fear of fatal reactions and the consequent change in life-style is more widespread because 0.4 to 0.8 per cent of the United States population has survived a systemic reaction to a sting.²³ Skin testing with extracts of crushed whole insect bodies, the only method widely employed for confirmation of such sensitivity, has been shown to be useless.⁴⁵ Treatment is with the same materials, and, although such a conclusion has been questioned, retrospective studies suggest that.