Stinging insect allergy: current perspectives on venom immunotherapy

Systemic allergic reactions to insect stings affect up to 5% of the population during their lifetime, and up to 32% of beekeepers. Such reactions can be fatal, albeit very rarely, and fear of a further systemic reaction (SR) can lead to significant anxiety and quality of life impairment. A recent Co...

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Published inJournal of asthma and allergy Vol. 8; no. default; pp. 75 - 86
Main Authors Ludman, Sian W, Boyle, Robert J
Format Journal Article
LanguageEnglish
Published New Zealand Dove Medical Press Limited 01.01.2015
Taylor & Francis Ltd
Dove Medical Press
Subjects
Adolescents
Allergic reaction
Allergies
Allergy
Analysis
Anaphylaxis
Anxiety
Apiculture
Bees
Drug therapy
Economic analysis
Fatalities
Gene expression
Immunotherapy
Insect bites
Oral administration
Quality of life
Review
Stings
Venom
United Kingdom
United Kingdom > UK
United States > US
quality of life
anaphylaxis
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Summary:Systemic allergic reactions to insect stings affect up to 5% of the population during their lifetime, and up to 32% of beekeepers. Such reactions can be fatal, albeit very rarely, and fear of a further systemic reaction (SR) can lead to significant anxiety and quality of life impairment. A recent Cochrane systematic review confirmed that venom immunotherapy (VIT) is an effective treatment for people who have had a systemic allergic reaction to an insect sting. VIT reduces risk of a further SR (relative risk 0.10, 95% confidence interval 0.03-0.28), but VIT also reduces risk of a future large local reaction, and significantly improves disease-specific quality of life. However, health economic analysis showed that VIT is generally not cost effective for preventing future SRs; most people are stung infrequently, most SRs resolve without long-term consequences, and a fatal outcome is extremely rare. VIT only becomes cost effective if one is stung frequently (eg, beekeepers) or if quality of life improvement is considered. Thus, for most people with insect sting allergy, anxiety and quality of life impairment should be the overriding consideration when making treatment decisions, highlighting the importance of a patient-centered approach. Areas which need to be explored in future research include efforts to improve the safety and convenience of VIT such as the use of sublingual immunotherapy; quality of life effects of venom allergy in children and adolescents as well as their parents; and the optimal duration of treatment.
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ISSN:1178-6965
1178-6965
DOI:10.2147/JAA.S62288