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2018

ANUÁRIO DO HOSPITAL DONA ESTEFÂNIA
REPOSITÓRIO MÉDICO CIENTÍFICO

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HYMENOPTERA VENOM IMMUNOTHERAPY IN A PEDIATRIC GROUP

Ana Castro Neves1; Cátia Alves1, Sónia Rosa1, Sara Prates1, Paula Leiria Pinto1,2

1- Serviço de Imunoalergologia, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisboa;.
2- CEDOC, Integrated Pathophysiological Mechanisms Research Group, Nova Medical School, Lisboa, Portugal

- XXXVI European Academy of Allergology Clinical Immunology, Helsínquia, 17-21 Junho 2017
- Apresentação como poster; publicação de resumo
- Reunião Internacional

Resumo:
Introduction: Venom immunotherapy (VIT) is effective in Hymenop- tera venom allergy, although data regarding the pediatric age is sparse. Objectives: To evaluate a group of pediatric patients submitted to hymenoptera VIT in our Immunoallergology Department, including the safety and efficacy of this procedure.
Material and Methods: A retrospective analyses was performed, concerning an eight-year period (1999 to 2016). Demographic data, atopy, allergic diseases, comorbidities, VIT protocol used and its safety and efficacy were assessed.
Results: The study population included 9 patients, 3 were females; median age of 12 years (6-14 years). Severe systemic reactions occurred in all patients (6 had grade III reaction and 3 had grade IV, according to Mueller classification of systemic reactions); 4 were sen- sitized to aeroallergens and 3 had allergic rhinitis; 5 patients lived in rural areas and 4 had beekeepers in the close family. Specific IgE to Apis mellifera (Api), Vespula vulgaris and Polistes dominus (Pol) were pos- itive in 8, 6 and 3 children, respectively, and skin testing to bee and wasp venoms were positive in 8 and 1 patients, respectively. Eight patients were submitted to bee VIT (3 with a rush protocol and 5 with an ultra-rush protocol) and 1 to Pol VIT (ultra-rush protocol). Five of the 8 bee VIT patients ended their treatment (VIT duration ranged from four to eleven years); in the others, the process is ongoing. Dur- ing the build-up phase, two patients submitted to the rush protocol presented adverse reactions (1 had bronchospasm and 1 extensive local reaction) and 1 patient submitted to the ultra-rush protocol had rhinitis. All patients reached the cumulative dose of 100 lg. During the maintenance phase, 2 patients had an extensive local reaction and one had rhinitis. Seven patients were re-stung and only one developed generalized urticaria and bronchospasm, which led to a raise in the maintenance dose to 200 lg. After VIT had been concluded, 2 patients were re-stung with no systemic reactions.
Conclusions: These data, although concerning few patients, showed that VIT in a pediatric population is safe and prevents recur- rences of systemic reactions after subsequent insect stings.

Palavras Chave: Hymenoptera Venom Immunotherapy