STANDARDIZED RAPID HYPOSENSITIZATION WITH A PURIFIED HYMENOPTERA TOXIN IN YELLOW JACKET ALLERGY

In Germany, insect allergies cause about 10-40 death per year. Startin g a specific immunotherapy (SIT) and its maintenance may be lifesaving for the allergic patients. Performing a prospective study,we exactly documented effects and side effects during the induction phase of SIT using a purified aqueous yellow jacket venom preparation in 20 patient s allergic to yellow jacket venom (clinical degree II-IV). Indication for the therapy was defined individually for each patient and was base d on a score incorporating the following criteria: a) clinical symptom s, b) in-vivo- and in-vitro testing, c) risk of re-sting. SIT was star ted under in patient conditions following a standardized 8 day protoco l. At the end of the induction phase all patients tolerated the mainte nance dose of 100 mu g of yellow jacket venom without complications ev en though all showed local side effects (threshold doses 0.01-10 mu g, median value 0.2 mu g). 40% of all patients showed subjective side ef fects (median value of threshold dose 30 mu g, range 0.2-60 mu g) and 30% showed objective side effects (median value of threshold dose 55 m u g, range 20-80 mu g); however, all side effects were clinically mild . When objective systemic side effects were seen,the cumulative daily dose was 39-210 mu g (median value 135 mu g), exceeding 100 mu g in 83 % of patients. Our prospective study confirmed that the chosen protoco l for SIT is effective in inducing tolerance to the venom preparation. However, using a purified aqueous yellow jacket preparation did not r esult in reduction of side effects.