The first dose is given under observation in the clinic and, if tolerated, the patient can then self-administer the treatment daily at home. Clinical follow-up to encourage compliance, monitor for adverse events and to adjust any medical treatment is still recommended. Efficacy parameters.  There are no efficacy parameters or biomarkers that reliably predict or indicate response to treatment [18]. Responses MK-1775 nmr in clinical trials have been assessed using symptom and medication scores and measuring quality of life using a validated questionnaire. Long-term efficacy has been shown with SCIT to grass pollen.

Patients who received treatment for a period of 3 years showed sustained benefit for 7–9 years following discontinuation of desensitization [13,31–34]. VIT is the only specific treatment currently available to reduce the severity and prevent the recurrence of systemic reactions (SR) in patients with a previous history of life-threatening SR or anaphylaxis to hymenoptera

insect sting [35–39]. It is highly effective, providing more than 90% protection from reactions to subsequent stings [35,40–42]. Furthermore, it induces a clinically significant improvement in health-related quality of life both in patients with a history of anaphylaxis as well as those see more with non-life-threatening SRs to hymenoptera stings [43,44]. For a successful clinical outcome in VIT a systematic approach with a good clinical history, and in some cases scrutiny of hospital records relating to previous reactions, are paramount. Knowledge of the insect involved is valuable in making the correct choice of venom. Honey bees usually leave the barbed

stinger behind, whereas wasps and hornets usually do not. Details of the circumstances surrounding the sting episode may also provide useful pointers with respect to the nature of the insect. Indications (Table 2).  Anaphylaxis to hymenoptera sting represents a clear indication for VIT [36–38]. However, in patients with non-life-threatening reactions other risk factors such as age, co-morbid conditions, occupation, hobbies, social circumstances and the patient’s own choice must be considered carefully prior to making a decision Liothyronine Sodium about pursuing VIT. Demonstration of venom-specific IgE is mandatory prior to initiating VIT. Venom immunotherapy is not indicated in patients with local reactions, irrespective of their severity, and further investigations are not warranted [36–38]. VIT must not be attempted in patients with history of non-IgE-mediated systemic reactions such as Guillain–Barré syndrome, peripheral neuritis, haematological and renal complications. Investigations.  Skin prick tests (SPT) are the first-line investigation and are carried out at a concentration of 0–100 µg/ml of standardized venom extract [39].