Congruence of the current practices in Hymenoptera venom allergic patients in Poland with EAACI guidelines

Department of Pediatrics, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow, Poland.
Archives of medical science : AMS 10/2011; 7(5):832-9. DOI: 10.5114/aoms.2011.25558
Source: PubMed


Venom immunotherapy (VIT) practice is the definitive treatment for patients with potentially fatal allergic reactions to Hymenoptera stings. The aim is assesing compliance of VIT practice in Poland with the current European Academy of Allergy and Clinical Immunology (EAACI) guidance.
A multicentre study was carried out using a structured questionnaire which was sent by post to all VIT practitioners in Poland. Some questionnaire items were altered, in comparison to original version by adding additional answer options or alowing multiple answer option. The response rate was 100%. The obtained results were compared with the published EAACI guidelines.
Twenty-six Polish centres took part in the survey. SSIgE and skin prick tests (SPT) are together used as the first line of investigation, whereas confirmatory intradermal tests (IDT) are applied in half of centres. Only a few centres measure baseline serum tryptase levels. The ultra-rush protocol is preferred. Antihistamine pre-medication is routinely practiced. A target dose equal to 100 µg is used in most centres. A 6-week interval between booster doses is the most frequent. Five years is considered as an optimal VIT duration. Before the VIT completion, SSIgE is evaluated in fifty percent of centres, whereas sting challenge is considered by half of responders.
There are some differences between current practice in Poland and the EAACI recommendations, indicating areas requiring better compliance. Comparision between Poland and the United Kingdom revealed that health service organization and health care funding may play a major role in the provision of allergy services. This may affect the extent to which international guidance may be applied in individual countries. It is worth considering conducting the same survey in other European countries.

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    • "We also observed a lower level of discomfort in patients treated with a longer lasting conventional protocol. From the medical point of view, shorter protocols, though requiring a higher number of subcutaneous injections in a short time, are safe, and they allow immunoprotection to be achieved in a shorter time, and at lower costs, so there is a rising tendency in health care to use shorter protocols worldwide, including in Poland [22]. It is also difficult to explain why a shorter duration of the initial phase of treatment may increase the feeling of discomfort expressed as being troubled by looking for insects in different situations. "
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    ABSTRACT: Hymenoptera venom allergy is common and can be very severe. The only effective preventive treatment is venom immunotherapy. The terms of diagnostic assessment and indications for treatment are based on guidelines from 2005 which need to be updated and, moreover, recent surveys have shown that current practices vary in spite of these guidelines. We wanted to make proposals to update guidelines on the diagnosis of hymenoptera allergy, in order to improve and standardize practices. We based our work on an extended analysis of the literature since publication of the EAACI guidelines and on the opinion of a working group from the French Society of Allergology. This work has allowed us to expand the indications for diagnostic assessment and reminds us that diagnosis requires intradermal skin tests and specific IgE assays, to which we can add the use of recombinant allergens and basal serum tryptase levels. The basophil activation test and reciprocal inhibition assays are considered as clinically useful and should be standardized and made available.
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