BACKGROUND: The safety profile of venom immunotherapy (VIT) is a relevant issue, and considerable differences have been reported in the safety and efficacy of this treatment modality. The primary aim of this study was to evaluate the safety of angiotensin-converting enzyme inhibitors and ß-blockers during VIT. In a second analysis, we evaluated data on premedication and venom preparations and their association with systemic adverse events (AEs) during the up-dosing phase and the first year of the maintenance phase, as well as the outcome of field stings and sting challenges. METHODS: Ours was an open, prospective, observational, multicenter study that recruited 1425 patients, of whom 1342 underwent VIT. RESULTS: Premedication with oral antihistamines was taken by 52.1% of patients during up-dosing and 19.7% of patients during the maintenance phase. Antihistamines had no effect on the frequency of systemic AEs (P=.11), although large local reactions (LLRs) were less frequent (OR, 0.74; 95%CI, 0.58-0.96; P=.02). Aqueous preparations were preferred for up-dosing (73.0%), and depot preparations were used for the maintenance phase (64.5%). The type of venom preparation had no influence on the frequency of systemic AEs or on the effectiveness of VIT (P=.26 and P=.80, respectively), while LLRs were less frequent with depot preparations (P<.001). CONCLUSIONS: Pretreatment with oral antihistamines during VIT significantly reduces the frequency of LLRs but not systemic AEs. All venom preparations were equally effective and did not differ in terms of the frequency of systemic AEs.

Allergology Department Medical University of Gdańsk Gdańsk Poland

Allergy Department Hospital Universitario Fundación Alcorcón Madrid Spain

Allergy Outpatient Clinic Reumannplatz Vienna Austria

Allergy Section of University Hospital Reina Sofia ARADyAL Network Maimonides Biomedical Research Institute of Córdoba Córdoba Spain

Allergy Unit Hospital Central de la Cruz Roja Faculty of Medicine Alfonso 10 El Sabio University ARADyAL Madrid Spain

Allergy Unit Sant´Anna Hospital Como Italy

Allergy Unit Verona General Hospital Verona Italy

Clinical Allergology Department Pomeranian Medical University Szczecin Poland

Clinical Department of Internal Diseases Dermatology and Allergology Medical University of Silesia Zabrze Poland

Department of Dermatology and Allergology Paracelsus Medical University Salzburg Salzburg Austria

Department of Dermatology and Allergy University Hospital Würzburg Würzburg Germany

Department of Dermatology and Venereology Medical University of Graz Graz Austria

Department of Dermatology General Hospital Ordensklinikum Linz GmbH Elisabethinen Linz Austria

Department of Dermatology Kepler University Hospital and Medical Faculty Johannes Kepler University Linz Austria

Department of Dermatology Venereology and Allergology Medical University of Innsbruck Innsbruck Austria

Department of Immunology and Allergology Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic

Department of Immunology and Allergology University Hospital Pilsen Czech Republic

Department of Internal Diseases Pulmonology and Allergology Medical University of Wroclaw Wroclaw Poland

Department of Internal Medicine Allergy and Clinical Immunology Silesian University of Medicine Katowice Poland

Department of Internal Medicine Division of Allergy and Immunology Medical Faculty Ege University Izmir Türkiye

Department of Internal Medicine Division of Immunology and Allergic Diseases Istanbul Faculty of Medicine Istanbul University Istanbul Türkiye

Department of Internal Medicine Fondazione IRCCS Ca´ Granda Ospedale Maggiore Policlinico Milan Italy

Department of Pulmonary Diseases Division of Immunology and Allergy Faculty of Medicine Ankara University Ankara Türkiye

High Specialization Unit of Allergology Hospital of Faenza AUSL of Romagna Romagna Italy

Institute for Medical Informatics Statistics and Documentation Medical University of Graz Graz Austria

Laboratorio Unico Metropolitano Maggiore Hospital Bologna Italy

SD Allergologia Clinica Azienda Ospedaliero Universitaria Pisana Pisa Italy

Servicio de Alergia Hospital Universitario Ramón y Cajal Madrid Spain

Servicio de Enfermedades del Sistema Inmune Alergia Hospital Universitario Príncipe de Asturias Departamento de Medicina y Especialidades Médicas Universidad de Alcalá Madrid Spain

University Clinic of Respiratory and Allergic Diseases Golnik and Medical Faculty Ljubljana Slovenia

University Clinic of Respiratory and Allergic Diseases Golnik Slovenia

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