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Eur Ann Allergy Clin Immunol. 2019 Jan 31. doi: 10.23822/EurAnnACI.1764-1489.85. [Epub ahead of print]

Venom Immunotherapy: A 20-year experience with an ultra-rush protocol (210-min)

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Serviço de Imunoalergologia, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte (CHULN), Lisboa, Portugal.
Laboratório de Imunologia Clínica, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa.
Clínica Universitária de Imunoalergologia, Faculdade de Medicina, Universidade de Lisboa.


Background. Ultra-rush (UR) are induction protocols used in venom immunotherapy (VIT). Objectives: To evaluate the adverse reactions during a 210-minutes UR and determine possible risk factors. Methods: Retrospective study of 129 patients submitted to UR with VIT in the last 20 years. Results: In 114 (88.4%) patients the 101.1 μg maintenance dose was reached in 210 minutes. Systemic reactions (SR) occurred in 22% of patients (71% mild). There were no severe SR, late reactions or fatalities. Adrenaline was administered in 10% of all UR. The SR were more frequent with honey bee VIT and had greater severity in the patients with a previous severe systemic sting reaction. No significant difference in the risk of SR was found with other demographic, clinical or laboratory factors. There were 5% of large local reactions (LLR), these being more frequent in females. Conclusion: Most SR during UR were mild with no need for adrenaline treatment. The honey bee venom and the severity of the anaphylaxis during the field sting were the only SR´s risk factors for systemic adverse reactions during the UR.


Adverse reactions; honey-bee; paper wasp; ultra-rush; wasp

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