Safety of hymenopteran venoms immunotherapy in a cluster schedule. A nursing perspective

Abstract

Background. The inherent seriousness of IgE mediated hypersensitivity to hymenopteran venoms makes it necessary to reach, in the shortest period of time, the maintenance dose in immunotherapy with poisons. The aim of this article is to evaluate the safety of a cluster schedule of subcutaneous Hymenopteran venoms immunotherapy, which reduces the time needed to reach the maintenance dose from 12 to 3 weeks. Material and methods. Thirty patients, 24 men and 6 women with an average age of 46.06 years, who had been diagnosed with hypersensitivity to the poison of hymenopterans and for whom immunotherapy had been prescribed participated in the study. The patients received Pharmalgen® (ALK Abelló) immunotherapy against hymenopteran venoms, 13 Apis mellífera, 12 Véspula spp, and 5 Polistes spp, with a cluster schedule that consisted of: day 1 (4μg + 6μg), day 8 (10μg + 30μg) and day 15 (40μg + 60μg). The reactions occurring during the starting phase between April 2005 and February 2008 were evaluated. Results. Of the 30 vaccinated patients 2 presented an exaggerated local reaction, there were other non-specific symptoms on two occasions, and another 2 presented systemic reaction. One following administration of the dose of 40μg presented a grade III systemic reaction, and the other after receiving the dose of 60μg presented a grade II systemic reaction. Both passed to a conventional model of immunotherapy administration and had new grade III reactions, and were therefore kept on immunotherapy with premedication with oral antihistamines. Discussion. The study confirms that the model employed is safe with a low incidence of adverse reactions, 1.67% presented an exaggerated local reaction, 1.11% had an non-specific reaction and 1.11% a systemic reaction.