Rush and ultra-rush venom immunotherapy for Hymenoptera allergy
- Marc Serota, MD
Marc Serota, MD
- Associate Professor of Dermatology and Allergy
- Denver VA Medical Center and Denver University
- Jay M Portnoy, MD
Jay M Portnoy, MD
- Chief, Section of Allergy, Asthma and Immunology
- Children's Mercy Hospitals and Clinics
Venom immunotherapy (VIT) to treat systemic allergic reactions to winged Hymenoptera (hornets, yellow jackets, honey bees, and wasps) may be administered according to several different schedules. Accelerated schedules include "rush" and "ultra-rush."
This topic review will discuss the advantages and disadvantages of rush and ultra-rush schedules for VIT, indications for accelerated VIT, and provide several specific examples of protocols that have been used successfully. Conventional schedules for VIT are discussed separately. (See "Hymenoptera venom immunotherapy: Technical issues, protocols, adverse effects, and monitoring" and "Stings of imported fire ants: Clinical manifestations, diagnosis, and treatment".)
Terminology — All forms of subcutaneous immunotherapy (SCIT) are divided into two phases: build-up and maintenance.
●The build-up phase involves serial injections of increasing amounts of allergen. During this phase, tolerance to the allergen is gradually induced and the patient's immune response to the allergen is modified from a T helper type 2 (Th2) phenotype to a T helper type 1 (Th1) phenotype [1,2]. In conventional VIT schedules, the build-up phase involves one or three injections per week and extends from 8 to 21 weeks. Conventional schedules for VIT are shown in the tables (table 1 and table 2). Th2 and Th1 responses are reviewed separately. (See "T helper subsets: Differentiation and role in disease", section on 'Functional differences of T helper subsets'.)
●The maintenance phase of allergen immunotherapy involves ongoing injections of an immunizing dose of allergen, usually at intervals of three to six weeks. During the maintenance phase, the immune transformation becomes complete. This phase is usually extended for a period of three to five years because shorter durations of treatment are associated with higher rates of recurrent systemic allergic reactions to subsequent stings. (See "Hymenoptera venom immunotherapy: Determining duration of therapy", section on 'Duration of treatment'.)
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- - Rush
- - Ultra-rush
- ADVANTAGES AND SAFETY OF ACCELERATED IMMUNOTHERAPY
- - Rates of systemic allergic reactions
- CONSENT, STAFFING, AND EQUIPMENT
- Informed consent
- Staffing and equipment
- SPECIFIC PROTOCOLS
- 135 minutes
- 150 minutes
- Four hours
- One day
- Two days
- MANAGEMENT OF ADVERSE REACTIONS
- Systemic reactions
- Large local reactions
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS