Food, drug, insect sting allergy, and anaphylaxisUltrarush versus semirush initiation of insect venom immunotherapy: A randomized controlled trial
Section snippets
Participants
Between September 2006 and November 2008, we recruited volunteers of any age with a history of 1 or more immediate generalized allergic reactions to known or suspected JJA stings plus evidence of JJA venom-specific IgE (sIgE) by positive serology (Phadia CAP, Pharmacia Diagnostics, Uppsala, Sweden; positive cutoff 0.35 kU/L) or a positive intradermal skin test result, performed to a maximum concentration of 1.0 μg/mL.4 Exclusion criteria were negative serology for sIgE and a negative
Results
Between September 4, 2006, and November 11, 2008, 228 people were judged eligible for the trial on the basis of clinical histories and physical health. We excluded 15 because of negative skin test results and negative serology for sIgE to JJA venom. Ninety-three agreed to randomization of the initiation method—44 to semirush and 49 to ultrarush (Fig 1). Table II shows baseline characteristics including allocated target maintenance doses. Of the 120 who declined randomization, 31 selected
Discussion
We confirmed our previous findings that semirush VIT has an excellent safety profile with severe reactions being rare and found that systemic allergic reactions, including hypotensive anaphylaxis, were more likely with ultrarush treatment. A lower maintenance target dose reduced reaction risk after the initiation phase, but the efficacy of this lower dose is not yet known. Maximal increases in sIgE also occurred earlier and were more intense with ultrarush VIT, suggesting enhanced sensitization
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This research was sponsored and funded by the Department of Health and Human Services, Tasmanian Government. The Royal Perth Hospital Medical Research Foundation, Western Australia, provided funding for the laboratory studies. S.G.A.B. was supported by the Australian National Health and Medical Research Council (NHMRC), Career Development Award 513901. The sponsor of the study had no role in study design, data collection, data analysis, data interpretation, or the writing of the report.
Disclosure of potential conflict of interest: S. G. A. Brown and M. D. Wiese received research support from the National Health and Medical Research Council (NHMRC) Australia and the Department of Health and Human Services (DHHS) Tasmania. T. Wanandy is employed by the DHHS Tasmania. R. J. Heddle received research support from the DHHS, the Royal Perth Hospital Medical Research Foundation, and the Australian NHMRC. The rest of the authors declare that they have no relevant conflicts of interest.