A Controlled Trial of Immunotherapy in Insect Hypersensitivity

TLDR

Insect hypersensitivity is commonly treated with whole‑body extract immunization. The study compared whole‑body extract immunization, venom immunotherapy, and placebo in 20 matched patients evaluated by skin test, histamine release, and IgE. Venom immunotherapy significantly lowered systemic sting reactions versus whole‑body extract or placebo (P < 0.01), which performed similarly and were less effective.

Abstract

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 less than 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.