Impact of specific immunotherapy and sting challenge on the quality of life in patients with hymenoptera venom allergy

Abstract

Background: An experienced life-threating anaphylactic reaction to hymenoptera venom can sustainably impair patients' quality of life (QoL). Besides carrying emergency medication, venom-specific immunotherapy (VIT) exists as a causal treatment of allergy.

Objective: This study aimed to examine QoL, anxiety, depression, and physical and mental health in patients allergic to hymenoptera venom before and during VIT and the impact of a tolerated sting challenge (SC).

Methods: Between July 2017 and August 2017, 142 patients with venom allergy were analyzed using validated questionnaires as the: Vespid Allergy Quality for Life Questionnaire" (VQLQ-d), the "Hospital Anxiety and Depression Scale" (HADS-D) and the "Short Form 36" (SF-36). To evaluate the impact of VIT and SC on the QoL, patients were divided into 3 groups: (A) VIT and tolerated SC (n = 45), (B) VIT before carrying out SC (n = 73), and (C) therapy-naïve before VIT (n = 20). Further parameters like gender, age, insect species, and severity of the anaphylactic reaction were assessed.

Results: A significant correlation between the health-related QoL and the parameters of gender and state of treatment was seen. Especially male patients, as well as patients allergic to yellow jacket venom, benefit from a SC in terms of a significant increase in their QoL. In the total study cohort, a clear trend was observed towards a higher QoL in patients under VIT who tolerated a SC. Overall, neither the patients' age nor the insect species exerted a relevant influence on QoL, depression or anxiety. However, women showed a lower QoL combined with higher anxiety and depression scores than men.

Conclusion: Immunotherapy leads to an improved QoL, which can be further increased by a SC. A tolerated SC conceivably reassures the patients by objectifying the treatment success. Female patients appear to have a stronger impaired QoL per se. Taken together, a SC can be performed during VIT to strengthen the patients' QoL.

Keywords: Hymenoptera venom allergy; Immunotherapy; Quality of life; Sting challenge.

Fig. 1

Patient cohort. This flowchart illustrates the sample sizes of the study population. The total patient cohort comprised n = 142 patients (57 men, 85 women). 4 female non-responders to VIT as well as any incorrectly completed questionnaire were excluded from statistical analysis. Thus, sample numbers can vary. The patients were divided into 3 subgroups according to their state of treatment: group A contains patients under VIT after a tolerated sting challenge, group B patients under VIT before carrying out sting challenge and group C therapy-naïve patients before VIT. Abbreviations: VIT = venom immunotherapy, m = male, f = female, VQLQ=Vespid Allergy Quality for Life Questionnaire, HADS=Hospital Anxiety and Depression Scale, SF-36 = Short Form 36

Fig. 2

Subgroup analysis for quality of life. This figure illustrates the quality of life (QoL) measured by the VQLQ-d according to the state of treatment. Patients were divided into 3 subgroups: (A) VIT after a tolerated sting challenge, (B) VIT before carrying out a sting challenge and (C) therapy-naïve patients before VIT. Panel (a) shows the overall cohort stratified by treatment subgroups: post-hoc analyses did not detect significant between-group differences. Panel (b) plots the gender-specific differences in the overall cohort, where women exhibited a significantly more impaired QoL than men (p = 0.0347 using Wilcoxon rank-sum test). In panel (c) exclusively male patients are stratified by treatment subgroups: group A showed a significantly higher QoL than group C (p = 0.0270 in post-hoc analyses). Panel (d) depicts solely patients allergic to yellow jacket venom: group A displayed a significantly increased QoL compared to group B and C (p = 0.0344 respectively in post-hoc analyses). For comparison of 3 samples Kruskal-Wallis test and for post-hoc analyses Conover-Iman test and Holm-Bonferroni method were applied. The level of statistical significance was set at p < 0.05