TY - JOUR
T1 - Clinical and immunologic observations in patients who stop venom immunotherapy
AU - Golden, David B.K.
AU - Johnson, Kevin
AU - Addison, Bonnie I.
AU - Valentine, Martin D.
AU - Kagey-Sobotka, Anne
AU - Lichtenstein, Lawrence M.
N1 - Funding Information:
From The Johns Hopkins University School of Medicine, Depart-ment of Medicine, Division of Clinical Immunology, The Good Samaritan Hospital, Baltimore, Md. Supported by Grant AI08270 from the National Institute of Allergy and Infectious Diseases. Received for publication Sept. 24, 1984. Accepted for publication Aug. 1, 1985. Reprint requests: David B. K. Golden, M.D., Johns Hopkins Wni-versity School of Medicine, Dept. of Medicine, Div. of Clinical Immunology, The Good Samaritan Hospital, 5601 Loch Raven Blvd., Baltimore, MD 21239. Publication No. 633 from the O’Neill Research Laboratories, The Good Samaritan Hospital, Baltimore, Md.
PY - 1986/3
Y1 - 1986/3
N2 - It is currently recommended that venom immunotherapy (VIT) be continued as long as the sensitivity persists (indicated by positive venom skin tests or RAST). In this pilot study, we performed a retrospective survey of the clinical and immunologic effects of stopping VIT. The 82 patients studied had received maintenance VIT for a mean of 14 months and had stopped VIT a mean of 43 months before evaluation. Subsequent "field" stings in 28 patients caused systemic reactions in six cases (22%), which is significantly higher than the 1% to 3% systemic reaction rate in patients who remain on maintenance VIT. The 22% reaction rate is a minimal estimate caused by loss of venom sensitivity in some patients and residual venom-specific IgG antibody levels in others. Reevaluation of venom skin tests and IgG levels was possible in 43 patients. A tenfold decline from before VIT skin test results was observed in 27 patients (63%). Skin tests remained clearly positive in 32/43 (74%), became weakly positive in 9/43 (21%), and 2/43 (5%) became negative. The IgG level declined from typical maintenance levels before stopping VIT (mean 7.2 ± 1.2 μg/ml) to levels typical of untreated patients at the time of retesting (mean 1.95 ± 0.3 μg/ml). Despite the marked fall of IgG antibody, one third of the patients still had levels in the average range observed in patients receiving maintenance VIT. We conclude that there is a substantial risk of anaphylactic sting reaction if VIT is stopped while venom sensitivity persists.
AB - It is currently recommended that venom immunotherapy (VIT) be continued as long as the sensitivity persists (indicated by positive venom skin tests or RAST). In this pilot study, we performed a retrospective survey of the clinical and immunologic effects of stopping VIT. The 82 patients studied had received maintenance VIT for a mean of 14 months and had stopped VIT a mean of 43 months before evaluation. Subsequent "field" stings in 28 patients caused systemic reactions in six cases (22%), which is significantly higher than the 1% to 3% systemic reaction rate in patients who remain on maintenance VIT. The 22% reaction rate is a minimal estimate caused by loss of venom sensitivity in some patients and residual venom-specific IgG antibody levels in others. Reevaluation of venom skin tests and IgG levels was possible in 43 patients. A tenfold decline from before VIT skin test results was observed in 27 patients (63%). Skin tests remained clearly positive in 32/43 (74%), became weakly positive in 9/43 (21%), and 2/43 (5%) became negative. The IgG level declined from typical maintenance levels before stopping VIT (mean 7.2 ± 1.2 μg/ml) to levels typical of untreated patients at the time of retesting (mean 1.95 ± 0.3 μg/ml). Despite the marked fall of IgG antibody, one third of the patients still had levels in the average range observed in patients receiving maintenance VIT. We conclude that there is a substantial risk of anaphylactic sting reaction if VIT is stopped while venom sensitivity persists.
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U2 - 10.1016/0091-6749(86)90177-6
DO - 10.1016/0091-6749(86)90177-6
M3 - Article
C2 - 3950251
AN - SCOPUS:0022652424
VL - 77
SP - 435
EP - 442
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
SN - 0091-6749
IS - 3
ER -