Q:

I was surprised to read in a recent review of stinging insect allergy in the Annals of Allergy that a 15-20 week period was standard during initiation of venom immunotherapy. For many years I have routinely used a 12 week build up based on the original recommendations. Did I read the review correctly? I would appreciate it if a specific dose and schedule of recommended injections during initiation of venom injection treatment could be provided. Thank you in advance for your help.

A:

Thank you for your inquiry.

I assume that you are referring to the review by Dr. David Golden, “Advances in Diagnosis and Management of Insect Sting Allergy” appearing in the Annals of Allergy, Asthma, and Immunology 2013; 111(2):84-89. With this in mind, I am going to ask Dr. Golden, who as you know is a nationally recognized authority in hymenoptera allergy, to reply to your inquiry. As soon as we receive his response, we will forward it to you.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

We have received a response from Dr. David Golden. Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. David Golden:

I find that many allergists use immunotherapy schedules that they learned during fellowship training, and may vary at different institutions. I was referring in my review article to the FDA-approved schedules that are shown in the product package inserts of the 2 approved venom products. These are shown in my Middleton's textbook chapter. The schedule we have used at Johns Hopkins for the past 35 years is actually a 7-week build-up. On the other hand, I am aware of many allergists who use extremely cautious schedules for venom, only achieving the maintenance dose after 6-12 months of treatment. It has been shown that slower schedules are not safer for VIT and may even result in a greater number of reactions because of the greater cumulative number of injections given. There is not necessarily any reason to change the schedule you are comfortable with.
 
David Golden

AAAAI - American Academy of Allergy Asthma & Immunology