Muller, U. R. et al. Clinical and immunol.ogic effects of H1 antihistamine preventive medication during honeybee venom immunotherapy. J. Allergy Clin. Immunol. 122, 1001-1007

Medizinische Klinik, Spital Ziegler, Bern, Switzerland.
The Journal of allergy and clinical immunology (Impact Factor: 11.48). 11/2008; 122(5):1001-1007.e4. DOI: 10.1016/j.jaci.2008.08.007
Source: PubMed


H1 antihistamines increase safety during allergen-specific immunotherapy and might influence the outcome because of immunoregulatory effects.
We sought to analyze the influence of 5 mg of levocetirizine (LC) on the safety, efficacy, and immunologic effects of ultrarush honeybee venom immunotherapy (BVIT).
In a double-blind, placebo-controlled study 54 patients with honeybee venom allergy received LC or placebo from 2 days before BVIT to day 21. Side effects during dose increase and systemic allergic reactions (SARs) to a sting challenge after 120 days were analyzed. Allergen-specific immune response was investigated in skin, serum, and allergen-stimulated T-cell cultures.
Side effects were significantly more frequent in patients receiving placebo. Four patients receiving placebo dropped out because of side effects. SARs to the sting challenge occurred in 8 patients (6 in the LC group and 2 in the placebo group). Seven SARs were only cutaneous, and 1 in the placebo group was also respiratory. Difference of SARs caused by the sting challenge was insignificant. Specific IgG levels increased significantly in both groups. Major allergen phospholipase A(2)-stimulated T cells from both groups showed a slightly decreased proliferation. The decrease in IFN-gamma and IL-13 levels with placebo was not prominent with LC, whereas IL-10 levels showed a significant increase in the LC group only. Decreased histamine receptor (HR)1/HR2 ratio in allergen-specific T cells on day 21 in the placebo group was prevented by LC.
LC reduces side effects during dose increase without influencing the efficacy of BVIT. LC modulates the natural course of allergen-specific immune response and affects the expression of HRs and cytokine production by allergen-specific T cells.

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    • "The EAACI Guidelines provide information about pretreatment with epinephrine to prevent anaphylaxis to snake anti-venom [4,123]. Surprisingly, no guidelines provide information about pharmacological prophylaxis of anaphylaxis from subcutaneous allergen immunotherapy, although H1-antihistamine pre-treatment before venom injections during VIT reduces systemic adverse events and has a beneficial immune-modifying effect [124] (Table 5). "
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