What is venom immunotherapy?

While the most common reaction to a sting from insects -- bees, wasps, hornets, yellow jackets, fire ants -- is local swelling, some people have a systemic reaction. A systemic reaction seriously affects multiple body systems and can be life threatening, especially if the airway is restricted. Venom immunotherapy (VIT) is the most effective treatment for people with systemic reactions to stings.

A patient who experiences a serious reaction should be evaluated immediately by a physician, who may administer epinephrine, lifesaving treatment in patients with systemic reactions. The patient then is referred to an allergy specialist. After an allergy is confirmed and identified, a rush protocol is begun that can last from eight to 12 weeks. As with other allergies, insect venoms contain substances that trigger reactions in some individuals. Twice a week, the allergy physician administers injections of a tiny amount of the insect venom, which contains the appropriate antigen. The physician gradually increases the dose, inducing the patient’s immune system to build resistance to the venom.

After completing the rush protocol, the allergy physician starts a maintenance protocol using the appropriate dose (usually 100 micrograms), with a new interval and duration for treatment. During the maintenance period, the patient receives injections once every four weeks for three to five years. The purpose is to induce clinical tolerance in the patient. Knowing the details of the patient’s reaction to the sting is essential in deciding the best course and duration for treatment.

Without treatment, an adult who has a systemic reaction has a 60 percent probability of having the same or worse reaction if stung again. The good news: While VIT does require extended treatment, the efficacy rate is high.
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