Use of B-Blockers during immunotherapy for Hymenoptera venom allergy
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.
Available from: PubMed Central
- "The issue of patients treated with immunotherapy and simultaneously receiving a β-adrenergic blocker is one that is commonly encountered and one that has generated intense interest as well as some controversy.18,19 This controversy has been generated in part because of the difficulties that are presented to the clinician when substitutions for β-blockers need to be made before the initiation of immunotherapy and because in some instances immunotherapy can be carefully performed even in patients who are receiving venom while on β-adrenergic blockers.20 In addition, it has been shown that β-adrenergic blockers may not increase the risk of anaphylactic events to radiocontrast material.21 "
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ABSTRACT: Anaphylactic events due to immunotherapy are probably not completely preventable. There is always an inherent risk surrounding the administration of an allergen to an individual who is sensitized to the substance administered.
There are, however, effective measures to reduce the risk of these events, and to optimize the assurance of a good outcome in the face of such an event.
Of prime importance in preventing these episodes is the regular assessment of the patient's health status, especially in regard to asthma, and the careful attention to the prevention of dosing errors.
Of equal importance, in regard to assuring a good outcome should such an event occur, are the rapid recognition of symptoms and the immediate injection of epinephrine, the drug of choice for the treatment of any episode of anaphylaxis.
American Journal of Rhinology and Allergy 11/2012; 26(6):469-74. DOI:10.2500/ajra.2012.26.3811 · 1.81 Impact Factor
Available from: Nicholas G Kounis
- "In a recent report , it was shown that more than 10% of patients with allergic reactions to hymenoptera stings have cardiovascular disease and about a third of them are receiving β-blockers. The authors of this study suggested that, in populations with high degree of exposure to hymenoptera stings such as beekeepers or gardeners who are suffering from coronary artery disease, heart failure or severe cardiac arrhythmias, immunotherapy should be applied under βblockade but with special precautions. "
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ABSTRACT: Kounis syndrome is the concurrence of acute coronary syndromes with conditions associated with activation of interacting inflammatory cells including allergic or hypersensitivity and anaphylactic or anaphylactoid insults. It is caused via inflammatory mediators released during inflammatory cell activation. A variety of conditions, drugs, and environmental exposures can induce Kounis syndrome. A patient suffering from coronary artery disease and taking metoprolol and aspirin was stung by wasps and developed cutaneous allergic signs including rash, urticaria and orbital oedema. This was followed by retrosternal pain, chest discomfort and electrocardiographic changes compatible with acute myocardial ischemia. Cardiac enzymes, troponins and blood pressure remained normal but serum tryptase was raised. The clinical implications and pathophysiology of this rare association are discussed.
International journal of cardiology 10/2007; 121(1):105-8. DOI:10.1016/j.ijcard.2006.08.039 · 4.04 Impact Factor
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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 reports
System Sciences, 1989. Vol.II: Software Track, Proceedings of the Twenty-Second Annual Hawaii International Conference on; 02/1989
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