bee venom immunotherapy dr aarn huissoon consultant immunologist birmingham heartlands hospital
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Bee Venom Immunotherapy
Dr Aarn HuissoonConsultant Immunologist
Birmingham Heartlands Hospital
I reacted to a sting – do I need VIT?Large Local reaction• Swelling at the sting• Develops over ~24 hours• Settles over several days
• Antihistamines and steroids• Not usually a reason for VIT
Systemic reaction
• Symptoms in minutes• May include any of:
– Itch, rash, flushing– Swelling (e.g. skin, throat)– Tight chest / wheeze / can’t
breathe– Dizzy, faint, collapse– “Feeling of impending doom”– Stomach cramps / diarrhoea
• Antihistamines and adrenaline
• YES - assessment for VIT
What does VIT assessment involve?
• Detailed history of the reaction– Timings, treatments, blood tests etc..
• Allergy testing– Skin prick test– Intradermal test– Blood test; bee venom IgE
• Breathing tests and ECG (some people)• Blood test; Tryptase
Immunotherapy Clinic
• Hospital-based• Run by doctors / nurses• Facilities for treating reactions• Well on the day• Pre-injection check• Wait for 1 hour after injection• Another check before home
What happens in VIT?
Build-up 12 weekly injections Increasing from 0.01 to 100 g / injn
Top-ups every 4-6 weeks for 3 yrs
100 g is ~3 stingsMay be 5 yrs or more
Risks of VIT
• Local or large local reactions in 50%
• Systemic reactions (SR)– 2 to 20 % of patients have SR– Risks for SRs:• Female• Bee allergy 14% (wasp 3%)
• Raised baseline tryptase
Outcomes of VIT• Protection– 80% prevention of severe reactions
• Quality of life improved• May also reduce large local reaction
Boyle RJ Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD008838
Outcomes of VIT
No VIT VIT
ANY systemic reaction to an insect
sting
(Bee or Wasp)
Low-risk population
83 per 1000 8 per 1000(2 to 23)
Medium-risk population
398 per 1000 40 per 1000(12 to 111)
High-risk population
724 per 1000 72 per 1000(22 to 203)
Boyle RJ Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD008838
How does VIT work?
• Type of immune response depends on how antigen is presented– Dose– Route (mouth, IV, ID SC…)
• Subcutaneous injections steer the immune response away from allergy
VIT for Bee sting allergy
• You should be able to have VIT if:– you have had a severe reaction to a bee sting
or– you have had a moderate reaction to a bee sting and you have• a high risk of stings• anxiety about stings• high levels of a protein called ‘tryptase’
Adapted from: www.nice.org.uk/guidance/ta246
Can anyone have VIT?
• Exclusions:– Severe asthma– Pregnancy– Not able to consent / attend reliably– Certain medications:• -blocker (e.g propranolol)• ACE inhibitor (e.g. ramapril)• Some antidepressants
– Some immune system disorders and cancers
Where can I go for VIT?
www.bsaci.org