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Ultrarush versus semirush initiation of insect venom immunotherapy: A randomized controlled trial


Brown, SGA and Wiese, MD and van Eeden, P and Stone, SF and Chuter, CL and Gunner, J and Wanandy, T and Phillips, M and Heddle, RJ, Ultrarush versus semirush initiation of insect venom immunotherapy: A randomized controlled trial, Journal of Allergy and Clinical Immunology, 130, (1) pp. 162-168. ISSN 0091-6749 (2012) [Refereed Article]

Copyright Statement

copyright 2012 American Academy of Allergy, Asthma & Immunology

DOI: doi:10.1016/j.jaci.2012.02.022


Background: Venom immunotherapy can be initiated by different schedules, but randomized comparisons have not been performed.

Objective: We aimed to compare the safety of 2 initiation schedules. Methods: Patients of any age with prior immediate generalized reactions to jack jumper ant (Myrmecia pilosula) stings were randomized to venom immunotherapy initiation by a semirush schedule over 10 visits (9 weeks) or an ultrarush schedule over 3 visits (2 weeks). In a concurrent treatment efficacy study, the target maintenance dose was randomized to either 50 μg or 100 μg. The primary outcome was the occurrence of 1 or more objective systemic reactions during venom immunotherapy initiation. Analyses were by intention to treat. We also assessed outcomes in patients who declined randomization.

Results: Of 213 eligible patients, 93 were randomized to semirush (44 patients) or ultrarush (49 patients) initiation. Objective systemic reactions were more likely during ultrarush initiation (65% vs 29%; P < .001), as were severe reactions (12% vs 0%; P = .029). Times to maximal increases in venom-specific IgG4 were no different between treatments, whereas the maximal increase in venom-specific IgE occurred earlier with ultrarush treatment. Similar differences between methods were observed in patients who declined randomization. One hundred seventy-eight patients were randomized to maintenance doses of either 50 μg (90 patients) or 100 μg (88 patients). The target maintenance dose had no effect on the primary outcome, but multiple-failure-per-subject analysis found that the 50 μg dose reduced the likelihood of reactions.

Conclusion: Ultrarush initiation increases the risk of systemic reactions. A lower maintenance dose reduces the risk of repeated reactions, but the effect on treatment efficacy is unknown.

Item Details

Item Type:Refereed Article
Keywords:insect sting allergy, anaphylaxis, immunotherapy, venom immunotherapy, randomized controlled trial
Research Division:Biomedical and Clinical Sciences
Research Group:Immunology
Research Field:Allergy
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Wanandy, T (Mr Troy Wanandy)
ID Code:82086
Year Published:2012
Web of Science® Times Cited:36
Deposited By:Menzies Institute for Medical Research
Deposited On:2013-01-16
Last Modified:2017-11-07

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