Treatment failures with whole-body extract therapy of insect sting allergy

D. B. Golden, J. Langois, M. D. Valentine, A. Kagey-Sobotka and L. M. Lichtenstein

Whole-body extracts (WBEs) remain in widespread use for therapy of insect sting anaphylaxis two years after the approval of Hymenoptera venoms. We have reviewed our experience with WBEs in our patient population. Of 250 patients who received WBE, 115 had subsequent stings. Systemic allergic reactions occurred in 65% large local reactions in 23%, and no reaction in 12%. There was no consistent change in the severity of systemic reactions during WBE treatment. Systemic reaction occurred less commonly in younger persons or after at least two years of WBE treatment. We conclude that WBE is not effective for the prevention of allergic insect sting reactions. The natural history of the disease may account for its apparent efficacy in young people or those having prolonged WBE therapy. Venom immunotherapy is safe and rapidly effective and is the only protective treatment recommended.