Controlled Trial of Immunotherapy in Insect Hypersensitivity

At least 50 deaths per year follow hymenoptera stings. Skin testing to test sensitivity is useless. Whole insect body extract is likely to be effective but not ideal (Lichtenstein LM, et al: N Engl J Med 290:1223, 1974). In a controlled study of selected patients at significant risk, whole body extract, venom extract, and placebo were compared. Sting challenges were done after the immunotherapy; 7 of 12 and 7 of 11 patients receiving placebo or whole body extract had systemic reaction to challenge, and 1 of 18 receiving venom extract had such a reaction. Venom immunotherapy is clearly superior. The optimal regime has not yet been defined, however, nor have the criteria for treatment.