Abstract

210 min (group 3) rapid venom immunotherapy (RVIT) protocol using honey bee or yellow jacket venom at cumulative doses of 527.6 I-tg, 226.6 I-tg and 101.1I-tg, respectively. The four day protocol involved four times as many injections as the 210 min protocol and twice as many injections as the 6 h protocol. Desensitization was conducted in a hospital providing full emergency resuscitation facilities. In group 1, 1 X 100 I-tg boosters were given on days 7, 10, 15 and 45; and in groups 2 and 3, 2 X 50 I-tg boosters were given on day 15 and 1 X 100 I-tg on day 45. The patients in the three groups were comparable in clinical characteristics and immunological reactivity determined by skin tests. All patients had large local reactions. Systemic reactions occurred in 28.2% of patients in group 1, 28.6% in group 2 and 6.9% in group 3. The mean total cumulative venom dose for occurrence of systemic reactions was 123.75 (± 24.2) in group 1, 183.27 (± 28.5) in group 2 and 36.43 (± 9.3) in group 3. Honey bee venom led to more systemic reactions than did yellow jacket venom. The rate of systemic reactions decreased when the cumulative venom dose was reduced during RVIT. The median dose was 137.6 !!g in group 1, 226.6 I-tg in group 2 and 21.1 !!g in group 3. No systemic reactions were observed after the booster injections. The results of this study suggest that short RVIT protocols with low cumulative doses carry a lesser risk of systemic reaction and that a 210 min venom immunotherapy protocol is safe. Since October 1986, we have been using the 210 min protocol routinely in our Department of Chest Diseases. Immediate systemic reactions have been mild and have responded readily to properly supervised treatment. Although no late reactions have been observed so far, we advise patients to stay in the hospital for the night following rapid venom immunotherapy.