Rush build-up of venom immunotherapy using a depot preparation: learning from times of shortage

Abstract

Background

Aluminum hydroxide-adsorbed venom depot products are promoted for conventional build-up protocols and the maintenance phase of honeybee and Vespula venom immunotherapy (VIT) to improve treatment tolerability and support a sustained immune response. Published data regarding their off-label use during inpatient rush build-up of VIT are scarce.

Methods

During a recent supply shortage, an aluminum hydroxide-adsorbed depot product instead of the corresponding aqueous venom preparation was used for VIT build-up according to a standardized 3‑day rush protocol in 59 consecutive patients. Side effects during VIT build-up and subsequent transition to the maintenance phase of treatment were retrospectively evaluated.

Results

Local tolerability of the depot product was excellent; VIT-induced large local reactions exceeding 10 cm in diameter were documented in only 3 patients (5.1%). There was no indication of an increased rate of VIT-induced systemic reactions. One patient developing a moderately severe anaphylactic reaction on day 2 of honeybee VIT build-up promptly stabilized upon antiallergic treatment. No objective systemic reactions were observed during transition to outpatient VIT maintenance using the same depot product.

Conclusion

Due to their excellent local tolerability, depot preparations represent a promising option for VIT rush build-up.