Safety and tolerability during build-up phase of a rush venom immunotherapy

Background Safety and tolerability of venom immunotherapy (VIT) in patients with concomitant disease and comedications, especially β-blockers (BBs) and angiotensin-converting enzyme inhibitors (ACEIs), are under discussion. Objective To identify risk factors for the occurrence of systemic reactions (SRs) during the build-up phase of a 3-day rush VIT with focus on comorbidities and related comedications. Methods Data of 175 three-day rush VIT courses ( Vespula venom, n = 161; honeybee venom, n = 14) were analyzed. Starting with 0.02 μg of venom, the maintenance dose of 100 μg was reached in 15-dose increments within 3 days. Local reactions (LRs) and SRs were documented during the build-up phase. Comorbidities and related comedications were registered. Univariate, bivariate, and multivariate data analysis was performed. Results During the 3-day rush VIT, an LR was seen in 74 (42.3%) of 175, a large LR (>10-cm diameter) in 82 (46.9%) of 175, and SRs in 19 (10.9%) of 175 VIT courses. Multivariate logistic regression revealed that female sex ( P = .01), immunotherapy with honeybee venom ( P = .003), and accompanying ACEI medication ( P = .03) were independent predictors of the development of SRs during the build-up phase of VIT. Conclusion This study revealed that female sex, honeybee VIT, and ACEI use independent predictors for SRs.