Use of β-blockers during immunotherapy for Hymenoptera venom allergy
ABSTRACT Beta-blockers may aggravate anaphylactic reactions and interfere with treatment. There is therefore concern about their use in patients who have a history of anaphylaxis or are on allergen immunotherapy. Immunotherapy is the best available treatment for prevention of life-threatening anaphylaxis to Hymenoptera stings, which is often observed in elderly patients who have cardiovascular disease and therefore are on beta-blocker treatment.
To analyze the risk of beta-blocker treatment during venom immunotherapy.
We screened all 1682 patients with Hymenoptera venom allergy seen during a period of 34 months for immunotherapy, cardiovascular disease, and treatment with beta-blockers.
Of the 1389 patients in whom immunotherapy was recommended, 11.2% had cardiovascular disease, and 44 of these were on beta-blockers before immunotherapy. In 31 of those, the drug was replaced before starting treatment. In 3 with coronary heart disease and 1 with severe ventricular arrhythmia, the drug was continued throughout immunotherapy. In 9, it was reintroduced after reaching the maintenance dose. In an additional 12 patients, beta-blockers were newly started during immunotherapy. Of 25 patients on beta-blockers during immunotherapy, 3 (12%) developed allergic side effects, compared with 23 (16.7%) of 117 with cardiovascular disease but without beta-blockers. Systemic allergic symptoms after re-exposure by sting challenge or field sting were observed in 1 of 7 (14.3%) with and 4 of 29 (13.8%) without beta-blockade. No severe reactions to treatment or sting reexposure were observed in patients with beta-blockade.
Combination of beta-blockers with venom immunotherapy may be indicated in heavily exposed patients with severe cardiovascular disease.
Conference Paper: Knowledge-based method and tool handling[Show abstract] [Hide abstract]
ABSTRACT: Method and tool selection are defined by a method rule system and a tool rule system. The former defines the order in which methods might be applied to perform a specific software-engineering task. Tools supporting the methods are managed by the tool system. A set of interrelation rules defines the transformation of a methodological refined task into a set of appropriate tools of a selected environment. Parameters and weights are used in both rule systems to distinguish alternative or complementary rules and to define preference for a selection process. Three methods of knowledge acquisition are examined: analysis of handbooks, usage protocols, and expert meeting reportsSystem Sciences, 1989. Vol.II: Software Track, Proceedings of the Twenty-Second Annual Hawaii International Conference on; 02/1989
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