EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

G J Sturm^{1

2}, E-M Varga³, G Roberts^{4

5}, H Mosbech⁶, M B Bilò⁷, C A Akdis⁸, D Antolín-Amérigo⁹, E Cichocka-Jarosz¹⁰, R Gawlik¹¹, T Jakob^{12

13}, M Kosnik¹⁴, J Lange¹⁵, E Mingomataj^{16

17}, D I Mitsias¹⁸, M Ollert^{19

20}, J N G Oude Elberink²¹, O Pfaar^{22

23}, C Pitsios²⁴, V Pravettoni²⁵, F Ruëff²⁶, B A Sin²⁷, I Agache²⁸, E Angier²⁹, S Arasi^{30

31}, M A Calderón³², M Fernandez-Rivas³³, S Halken³⁴, M Jutel^{35

36}, S Lau³⁷, G B Pajno³⁰, R van Ree³⁸, D Ryan³⁹, O Spranger⁴⁰, R G van Wijk⁴¹, S Dhami⁴², H Zaman⁴³, A Sheikh⁴⁴, A Muraro⁴⁵

Affiliations

¹ Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.
² Outpatient Allergy Clinic Reumannplatz, Vienna, Austria.
³ Department of Paediatric and Adolescent Medicine, Respiratory and Allergic Disease Division, Medical University of Graz, Graz, Austria.
⁴ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁵ Clinical and Experimental Sciences and Human Development in Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK.
⁶ Allergy Clinic, Copenhagen University Hospital Gentofte, Gentofte, Denmark.
⁷ Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Ancona, Italy.
⁸ Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Zurich, Switzerland.
⁹ Servicio de Enfermedades del Sistema Inmune-Alergia, Departamento de Medicina y Especialidades Médicas, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, Spain.
¹⁰ Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
¹¹ Department of Internal Medicine, Allergy and Clinical Immunology, Medical University of Silesia, Katowice, Poland.
¹² Department of Dermatology and Allergology, University Medical Center Gießen and Marburg (UKGM), Justus Liebig University Gießen, Gießen, Germany.
¹³ Allergy Research Group, Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany.
¹⁴ Medical Faculty Ljubljana, University Clinic of Respiratory and Allergic Diseases Golnik, Ljubljana, Slovenia.
¹⁵ Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland.
¹⁶ Department of Allergology & Clinical Immunology, Mother Theresa School of Medicine, Tirana, Albania.
¹⁷ Faculty of Technical-Medical Sciences, Department of Paraclinical Disciplines, Medicine University of Tirana, Tirana, Albania.
¹⁸ Department of Allergy and Clinical Immunology, 2nd Paediatric Clinic, University of Athens, Athens, Greece.
¹⁹ Department of Infection and Immunity, Luxembourg Institute of Health (LIH), Strassen, Luxembourg.
²⁰ Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark.
²¹ Department of Allergology and Internal Medicine, University of Groningen, University Medical Hospital Groningen & Groningen Research Center for Asthma and COPD (GRIAC), Groningen, The Netherlands.
²² Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Heidelberg, Germany.
²³ Center for Rhinology Allergology, Wiesbaden, Germany.
²⁴ Medical School, University of Cyprus, Nicosia, Cyprus.
²⁵ UOC Clinical Allergy and Immunology - IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
²⁶ Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, Munich, Germany.
²⁷ Department of Pulmonary Diseases, Division of Immunology and Allergy, Faculty of Medicine, Ankara University, Ankara, Turkey.
²⁸ Faculty of Medicine, Department of Allergy and Clinical Immunology, Transylvania University Brasov, Brasov, Romania.
²⁹ Department of Immunology and Allergy, Northern General Hospital, Sheffield, UK.
³⁰ Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy.
³¹ Molecular Allergology and Immunomodulation-Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany.
³² Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK.
³³ Allergy Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
³⁴ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
³⁵ Wroclaw Medical University, Wroclaw, Poland.
³⁶ ALL-MED Medical Research Institute, Wroclaw, Poland.
³⁷ Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany.
³⁸ Departments of Experimental Immunology and of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
³⁹ Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
⁴⁰ Austrian Lung Union, Vienna, Austria.
⁴¹ Section of Allergology, Department of Internal Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands.
⁴² Evidence-Based Health Care Ltd, Edinburgh, UK.
⁴³ School of Pharmacy, University of Bradford, Bradford, UK.
⁴⁴ Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
⁴⁵ Food Allergy Referral Centre Veneto Region Department of Women and Child Health, Padua General University Hospital, Padua, Italy.

PMID: 28748641
DOI: 10.1111/all.13262

Practice Guideline

EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

G J Sturm et al. Allergy. 2018 Apr.

. 2018 Apr;73(4):744-764.

doi: 10.1111/all.13262. Epub 2017 Dec 5.

Authors

Affiliations

¹ Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.
² Outpatient Allergy Clinic Reumannplatz, Vienna, Austria.
³ Department of Paediatric and Adolescent Medicine, Respiratory and Allergic Disease Division, Medical University of Graz, Graz, Austria.
⁴ The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁵ Clinical and Experimental Sciences and Human Development in Health Academic Units, Faculty of Medicine, University of Southampton, Southampton, UK.
⁶ Allergy Clinic, Copenhagen University Hospital Gentofte, Gentofte, Denmark.
⁷ Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Ancona, Italy.
⁸ Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Zurich, Switzerland.
⁹ Servicio de Enfermedades del Sistema Inmune-Alergia, Departamento de Medicina y Especialidades Médicas, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, Spain.
¹⁰ Department of Pediatrics, Jagiellonian University Medical College, Krakow, Poland.
¹¹ Department of Internal Medicine, Allergy and Clinical Immunology, Medical University of Silesia, Katowice, Poland.
¹² Department of Dermatology and Allergology, University Medical Center Gießen and Marburg (UKGM), Justus Liebig University Gießen, Gießen, Germany.
¹³ Allergy Research Group, Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany.
¹⁴ Medical Faculty Ljubljana, University Clinic of Respiratory and Allergic Diseases Golnik, Ljubljana, Slovenia.
¹⁵ Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland.
¹⁶ Department of Allergology & Clinical Immunology, Mother Theresa School of Medicine, Tirana, Albania.
¹⁷ Faculty of Technical-Medical Sciences, Department of Paraclinical Disciplines, Medicine University of Tirana, Tirana, Albania.
¹⁸ Department of Allergy and Clinical Immunology, 2nd Paediatric Clinic, University of Athens, Athens, Greece.
¹⁹ Department of Infection and Immunity, Luxembourg Institute of Health (LIH), Strassen, Luxembourg.
²⁰ Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, University of Southern Denmark, Odense, Denmark.
²¹ Department of Allergology and Internal Medicine, University of Groningen, University Medical Hospital Groningen & Groningen Research Center for Asthma and COPD (GRIAC), Groningen, The Netherlands.
²² Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Heidelberg, Germany.
²³ Center for Rhinology Allergology, Wiesbaden, Germany.
²⁴ Medical School, University of Cyprus, Nicosia, Cyprus.
²⁵ UOC Clinical Allergy and Immunology - IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
²⁶ Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, Munich, Germany.
²⁷ Department of Pulmonary Diseases, Division of Immunology and Allergy, Faculty of Medicine, Ankara University, Ankara, Turkey.
²⁸ Faculty of Medicine, Department of Allergy and Clinical Immunology, Transylvania University Brasov, Brasov, Romania.
²⁹ Department of Immunology and Allergy, Northern General Hospital, Sheffield, UK.
³⁰ Department of Pediatrics, Allergy Unit, University of Messina, Messina, Italy.
³¹ Molecular Allergology and Immunomodulation-Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany.
³² Section of Allergy and Clinical Immunology, Imperial College London, National Heart and Lung Institute, Royal Brompton Hospital, London, UK.
³³ Allergy Department, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
³⁴ Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.
³⁵ Wroclaw Medical University, Wroclaw, Poland.
³⁶ ALL-MED Medical Research Institute, Wroclaw, Poland.
³⁷ Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany.
³⁸ Departments of Experimental Immunology and of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
³⁹ Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
⁴⁰ Austrian Lung Union, Vienna, Austria.
⁴¹ Section of Allergology, Department of Internal Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands.
⁴² Evidence-Based Health Care Ltd, Edinburgh, UK.
⁴³ School of Pharmacy, University of Bradford, Bradford, UK.
⁴⁴ Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
⁴⁵ Food Allergy Referral Centre Veneto Region Department of Women and Child Health, Padua General University Hospital, Padua, Italy.

PMID: 28748641
DOI: 10.1111/all.13262

Abstract

Hymenoptera venom allergy is a potentially life-threatening allergic reaction following a honeybee, vespid, or ant sting. Systemic-allergic sting reactions have been reported in up to 7.5% of adults and up to 3.4% of children. They can be mild and restricted to the skin or moderate to severe with a risk of life-threatening anaphylaxis. Patients should carry an emergency kit containing an adrenaline autoinjector, H₁ -antihistamines, and corticosteroids depending on the severity of their previous sting reaction(s). The only treatment to prevent further systemic sting reactions is venom immunotherapy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Venom Immunotherapy as part of the EAACI Guidelines on Allergen Immunotherapy initiative. The guideline aims to provide evidence-based recommendations for the use of venom immunotherapy, has been informed by a formal systematic review and meta-analysis and produced using the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included representation from a range of stakeholders. Venom immunotherapy is indicated in venom-allergic children and adults to prevent further moderate-to-severe systemic sting reactions. Venom immunotherapy is also recommended in adults with only generalized skin reactions as it results in significant improvements in quality of life compared to carrying an adrenaline autoinjector. This guideline aims to give practical advice on performing venom immunotherapy. Key sections cover general considerations before initiating venom immunotherapy, evidence-based clinical recommendations, risk factors for adverse events and for relapse of systemic sting reaction, and a summary of gaps in the evidence.

Keywords: Hymenoptera venom allergy; anaphylaxis; effectiveness; safety; venom immunotherapy.

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EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

Affiliations

EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

Authors

Affiliations

Abstract

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials