Stoevesandt J, et al. – The incidence of anaphylactic side effects during rush venom immunotherapy (VIT) was evaluated in a cohort of pediatric patients and adult controls. In pediatric patients, the higher anaphylactic reaction rate was observed. This anaphylactic reaction rate appeared to be attributed to a greater prevalence of bee venom allergy. This study found mild VIT–induced anaphylaxis in children, and it did not affect further updosing and maintenance of VIT.

Methods

• Authors assessed 72 consecutive cycles of VIT-buildup in 71 children/adolescents aged 7–17 years.
• These cycles were compared to an adult control group (n = 981) with regard to baseline parameters (sex, causative venom, severity of index sting reaction, results of allergy testing, comorbidities) and the incidence of anaphylactic adverse reactions.

Results

• Results revealed that severe index sting-induced anaphylaxis was significantly less common in children (P = .001) than adults.
• It was noted that children were more likely to suffer from bee venom allergy (P < .001).
• They reported higher levels of bee venom-specific IgE (P = .013), but lower serum tryptase concentrations (P = .014) in these children.
• As compared to adults, the overall rate of VIT-induced anaphylactic reactions was higher in children (6.9% vs 2.5%, P = .046 by univariate analysis).
• However, only bee VIT (P = .039; odds ratio 2.25; confidence interval 1.04–4.87) and 5-day compared to 3-day buildup protocols (P = .011; odds ratio 2.64; confidence interval 1.25–5.57) were associated with an increased risk of treatment-induced anaphylaxis, in the final binary logistic regression model.
• They found that all pediatric patients finally reached and tolerated the target maintenance dose of 100 μg.