FCAAIA Notes: Have you or a loved on had al allergic reaction to a sting? Stinging insect allergy is probably one of the most curable things an allergist sees. For decades, it has been quite clear which patients are at risk of significant reactions to bee, wasp, or hornet stings and require venom immunotherapy (allergy shots). Risks of severe systemic reactions to subsequent stings can virtually be eliminated. Unfortunately, many patients who should be on shot are only prescribed self-injectable epinephrine and told to “be careful” as if there is no other therapy available.

Safety issues aside, this study also shows that patients who go on venom allergy shots also derive psychological benefit from the therapy.  Do you know if you are at risk of a severe reaction next time you are stung? Maybe you should see an allergist to find out!

(Source:  December 3, 2013. For Medscape articles: User name: FCAAIA, Password: Allergies)

Patients with insect venom allergy have lower levels of anxiety and depression if they receive venom immunotherapy than if they are prescribed an epinephrine autoinjector only or no rescue medication at all, a new study suggests.

This indicates that venom immunotherapy has utility for the biologic modulation of allergies and has a significant psychologic impact in the areas of anxiety and depression, the researchers, led by Timothy Craig, DO, professor of medicine and pediatrics at Penn State Milton S. Hershey Medical Center in Pennsylvania, report.

“Most doctors are not aware that there is immunotherapy available for venom allergy and I doubt patients know unless they see an allergist who does it,” Dr. Craig told Medscape Medical News. “The message of our study is that immunotherapy can decrease anxiety and improve depression.”

Dr. Craig’s colleague Sarah Findeis, MD, presented the findings here at the American College of Allergy, Asthma & Immunology (ACAAI) 2013 Annual Scientific Meeting.

From an initial pool of 437 patients with hymenoptera venom allergy treated at the Hershey Medical Center, 90 were interviewed by telephone about their type of medication and administered the Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A) to determine their level of psychological well-being.

The study cohort was 55% female, and 49% of the patients were taking no medication for their allergy, 39% used epinephrine only, and 12% were either undergoing or had previously received venom immunotherapy.

“Interestingly, of the 12% who had received venom immunotherapy, almost all also carried an epinephrine pen,” noted Dr. Findeis.

The mean rating of allergic severity on the Mueller Anaphylaxis Scale (MAS) was higher in the venom immunotherapy group than in the epinephrine group (2.82 vs 2.86), but the difference was not significant, “suggesting that some of the epinephrine group, based solely on their mean anaphylaxis rating, could qualify for venom immunotherapy,” she said.

The mean MAS rating in the nontreatment group was 1.32, which was significantly different from the 2 treatment groups (P < .001).

Despite having the most severe allergy rating, those in the venom immunotherapy group had the lowest anxiety and depression scores.

Table. Mean Anxiety and Depression Scores

Venom   immunotherapy 5.09 3.18
Epinephrine 7.67 7.67
No treatment 6.39 3.84

“Because this is a pilot study and there were so few patients, we had difficulty assigning statistically significance to anxiety and depression; however, we can see a general trend that we assume will hold true in larger studies,” Dr. Findeis noted.

Of the 20% of the study cohort classified as depressed, half were in the epinephrine group, meaning that a quarter of the epinephrine group was classified as depressed.

Additionally, all of the patients with moderate anxiety were in the epinephrine group; the only patient with severe anxiety was in the nontreatment group.

“This study suggests that, compared with other treatments, patients who are currently receiving or who have received venom immunotherapy have less anxiety and depression than those in other treatment groups, despite having very severe grades of anaphylaxis,” the researchers conclude.

Venom immunotherapy is not commonly pursued, despite the fact that 500,000 people go to the emergency department every year for sting reactions and there are 100 deaths annually in the United   States from insect venom allergy, Jay Portnoy, MD, chair of the ACAAI abstract committee, told Medscape Medical News.

“If someone has an allergic reaction to a sting and they are stung again, they have a 60% chance of having a reaction that is the same as or worse than the first,” he said.

“Most physicians don’t realize that venom allergy shots can be extremely effective — in fact they’re over 98% effective. They just give patients epinephrine injectors and tell them to avoid getting stung,” Dr. Portnoy noted. “But people are still very anxious about that.”

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