Eficacia y seguridad de la inmunoterapia específica en pacientes alérgicos al veneno de himenópterosinfluencia del tratamiento en la respuesta inmunológica al veneno y a sus componentes moleculares alergénicos

Abstract

OBJECTIVES: 1. To asses the tolerance, efficacy and long-term effect of venom immunotherapy (VIT) and to monitor in vivo and in vitro changes after 5 years of treatment and subsequent follow-up. 2. To study the influence of VIT on specific immunoglobulin E (sIgE) to individual allergens before and after three years of treatment. METHODS A total of 606 patients allergic to hymenoptera venom (467 to bee, 139 to wasp) were studied. All of them received VIT (Apis or Vespula. Two patients received an extract of Polistes dominulus). Cutaneous tests (ID) and sIgE were performed in all patients and in 35 of them, sIgE to main individual hymenoptera allergens (Api m 1, Api m 2, Ves v 1, Pol d 1, Ve v 2, Ves v 5 and Pol d 5) was measured before and after 3 years of treatment. RESULTS: The treatment was completed in 462 patients. During/after treatment 141/73 patients sensitized to Apis and 53/25 to Vespula suffered spontaneous re-stings. The 95,7% patients sensitized to Apis and 100% sensitized to Vespula suffered a local reaction or no-reaction. At the end of treatment, the cutaneous response (ID) and sIgE level to whole venom extract decreased significantly. Reductions in sIgE to main allergens were also observed after 3 years of treatment (Api m1: p <0.001; Api m2: p=0.0270; Ves V5: p=0.0234). CONCLUSIONS: The lack of anaphylactic reactions to spontaneous re-stings shows that VIT protected during the treatment and this efficacy was maintained up to 8 years after completing treatment in a real-world setting. Determination of sIgE to individual venom allergens may offer new perspectives in the diagnosis and follow-up of these patien