Clinical and Molecular Allergy (Jan 2018)

A 13-year real-life study on efficacy, safety and biological effects of Vespula venom immunotherapy

  • Marcello Albanesi,
  • Andrea Nico,
  • Alessandro Sinisi,
  • Lucia Giliberti,
  • Maria Pia Rossi,
  • Margherita Rossini,
  • Georgios Kourtis,
  • Anna Simona Rucco,
  • Filomena Loconte,
  • Loredana Muolo,
  • Marco Zurlo,
  • Danilo Di Bona,
  • Maria Filomena Caiaffa,
  • Luigi Macchia

DOI
https://doi.org/10.1186/s12948-017-0079-y
Journal volume & issue
Vol. 16, no. 1
pp. 1 – 12

Abstract

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Abstract Background Hymenoptera venom immunotherapy (VIT) is a clinically effective treatment. However, little is known about its long-term clinical efficacy and biological effects. Several mechanisms have been proposed to account for VIT efficacy, including reduction of specific IgE and induction of allergen-specific IgG4, but the overall picture remains elusive. We investigated Vespula VIT clinical efficacy up to 8 years after discontinuation and the kinetics of Vespula-specific IgE and IgG4. Out of 686 consecutive patients we retrospectively selected and analysed a series of 23 patients with Vespula allergy that underwent a 5-year IT course, followed by a prolonged follow-up. Methods Clinical efficacy of VIT was assessed as number and severity of reactions to Vespula re-stinging events. The presence of Vespula-specific IgE and IgG4 was also monitored over time. Results During the VIT treatment, patients were protected, reporting no reactions or mild reactions in occasion of re-stinging events. This protection was entirely maintained during the follow-up, up to 8 years. Skin reactivity (reflecting mast cell-bound Vespula-specific IgE) and circulating Vespula-specific IgE levels declined substantially during VIT. Notably, this reduction was maintained over time during the follow-up. Moreover, all the patients were analysed for IgG4. A robust induction of Vespula-specific IgG4 was observed during the VIT course, with a substantial decline during the follow-up. Conclusions We conclude that Vespula VIT is a clinically effective treatment, which induces long-term protection after discontinuation. The reduction of specific IgE, assessed by skin tests and RAST, closely matches the VIT- induced protection, while the IgG4 induction seems not to be associated with VIT clinical efficacy in the long term.

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