Rush venom immunotherapy in patients experiencing recurrent systemic reactions to conventional venom immunotherapy

Background: An unknown number of venom-allergic patients fail to reach the maintenance dose (MD) during the build-up period of conventional venom immunotherapy (VIT) due to recurrent systemic reactions (SRs). Objective: To establish an alternative VIT protocol that will enable these patients to reach a full protective MD. Methods: Venom-allergic patients who had experienced recurrent SRs during the build-up period of conventional VIT underwent rush VIT. Results: Of the 9 patients who participated in this study, the 6 who underwent 8 treatment courses tolerated the rush VIT well and reached the MD within 3 days. In 3 of these patients, mild cutaneous SRs were overcome with loratadine. In 2 patients who experienced recurrent and more severe SRs, the original 3-day rush VIT had to be modified and extended to 5 days until the MD was reached. In a single patient who experienced an anaphylactic reaction, VIT was discontinued. Conclusions: Rush VIT is an appropriate therapeutic alternative that enables most patients with recurrent SRs throughout the build-up period of conventional VIT to reach a full protective MD.