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Immunotherapy recommended for patients allergic to insect stings

Venom immunotherapy has been cited as the best treatment option for patients allergic to stinging insects in a recent paper in the New England Journal of Medicine.

“As far as long-term therapy for people with stinging insect allergy, avoiding exposure to these insects is key, but the only treatment option that will actually prevent life-threatening anaphylactic reactions is venom immunotherapy,” Thomas B. Casale, MD, FAAAAI, executive vice president of the American Academy of Allergy, Asthma & Immunology (AAAAI) and of the University of South Florida Morsani College of Medicine in Tampa, said in a press release.

A. Wesley Burks

Casale and A. Wesley Burks, MD, FAAAAI, a past president of AAAAI, from the University of North Carolina at Chapel Hill School of Medicine, wrote that anaphylaxis due to an insect bite has only been reported in a small number of cases. However, stings from insects belonging to the order Hymenoptera are among the most influential causes of systemic allergic reactions.

Hymenoptera insects include Apidae (honeybees and bumblebees), Vespidae (hornets, wasps, and yellow jackets), and Formicidae (fire ants), according to Casale and Burks.

Venom immunotherapy is given subcutaneously, and about 80% to 90% of patients who receive it for 3 to 5 years do not have a severe reaction to a future sting, according to the press release.

“The other important thing to keep in mind is that patients with venom-specific IgE who have had a severe allergic reaction are at higher risk of having another severe allergic reaction,” Burks said in the press release. “It is imperative for these individuals to carry autoinjectable epinephrine and know how to use it in an emergency.”

Hymenoptera-induced anaphylactic reaction should be mitigated by the prompt administration of intramuscular epinephrine, they wrote. Casale and Burks recommend that patients who have had a systemic reaction to an insect sting be referred to an allergist/immunologist for testing of venom-specific IgE, according to researchers.

Disclosure: Burks reports consultancy for Abbott, McNeil, Gerson Lehrman Group Research; Dow AgroSciences, Merck, Novartis, Schering-Plough, Unilever, ExloraMed Development, Nordic Biotech Advisors, Nutricia North America, Perigo, Portola, Regeneron, and Perosphere; and stock in Allertein Therapeutics and Mast Cell Pharmaceuticals; and lecture fees for Mylan. Casale reports consultancy for Stallergenes, Genentech and Novartis; grant support from Novartis, Genentech, ALK-Albello, Merck, and Stallergenes; and lecture fees from ALK-Albello.