Rush venom immunotherapy program for honeybee sting sensitivity

Abstract The clinical and immunological effects of honeybee venom (HBV) immunotherapy were studied in 20 HBV-sensitive patients. Patients were treated once monthly in a hospital setting by "rush" immunotherapy; we aimed for a maximum single dose of 200 μg. One patient withdrew shortly after beginning therapy. Eleven patients required epinephrine during treatment for reversal of anaphylaxis. Patients who tolerated maximum doses were readmitted one month later for deliberate honeybee sting challenges. Stings were tolerated by 11 of 19 patients; 5 of the remaining 8 required epinephrine therapy. Twelve of 16 patients achieved long-term protection as determined by deliberate stings; 4 of 16 achieved partial protection. Three additional patients, who were treatment failures, were switched to weekly immunotherapy. IgE antibodies to HBV and phospholipase A (PLA) rose shortly after immunotherapy was begun and in many patients remained elevated above baseline values. Serum IgG antibodies to PLA rose steadily during therapy; there was no absolute level of IgG antibody which was protective for all patients. Although satisfactory long-term clinical results were achieved for most patients, the frequency of systemic reactions during the rush immunization caused us to abandon this form of treatment in favor of a once-weekly outpatient injection program.