1. Bee Venom Immunotherapy
Dr Aarn Huissoon
Consultant Immunologist
Birmingham Heartlands Hospital

2. I reacted to a sting – do I need VIT?
Large Local reaction
Systemic reaction
Swelling at the sting
Develops over ~24 hours
Settles over several days
Antihistamines and steroids
Not usually a reason for VIT
Symptoms in minutes
May include any of:
Itch, rash, flushing
Swelling (e.g. skin, throat)
Tight chest / wheeze / can’t breathe
Dizzy, faint, collapse
“Feeling of impending doom”
Stomach cramps / diarrhoea
Antihistamines and adrenaline
YES - assessment for VIT

3. What does VIT assessment involve?
Detailed history of the reaction
Timings, treatments, blood tests etc..
Allergy testing
Skin prick test
Intradermal test
Blood test; bee venom IgE
Breathing tests and ECG (some people)
Blood test; Tryptase

4. Immunotherapy Clinic Hospital-based Run by doctors / nurses
Facilities for treating reactions
Well on the day
Pre-injection check
Wait for 1 hour after injection
Another check before home

5. What happens in VIT? Build-up 12 weekly injections Top-ups every
Increasing from
0.01 to 100 mg / injn
Top-ups every
4-6 weeks for 3 yrs
100 mg is ~3 stings
May be 5 yrs or more

6. Risks of VIT Local or large local reactions in 50%
Systemic reactions (SR)
2 to 20 % of patients have SR
Risks for SRs:
Female
Bee allergy 14% (wasp 3%)
Raised baseline tryptase

7. Outcomes of VIT Protection Quality of life improved
80% prevention of severe reactions
Quality of life improved
May also reduce large local reaction
Boyle RJ Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD008838

8. ANY systemic reaction to an insect sting
Outcomes of VIT
No VIT
VIT
ANY systemic reaction to an insect sting
(Bee or Wasp)
Low-risk population
83 per 1000
8 per 1000 (2 to 23)
Medium-risk population
398 per 1000
40 per 1000 (12 to 111)
High-risk population
724 per 1000
72 per 1000 (22 to 203)
Boyle RJ Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD008838

9. How does VIT work?
Type of immune response depends on how antigen is presented
Dose
Route (mouth, IV, ID SC…)
Subcutaneous injections steer the immune response away from allergy

10. VIT for Bee sting allergy
You should be able to have VIT if:
you have had a severe reaction to a bee sting or
you have had a moderate reaction to a bee sting and you have
a high risk of stings
anxiety about stings
high levels of a protein called ‘tryptase’
Adapted from:

11. Can anyone have VIT? Exclusions: Severe asthma Pregnancy
Not able to consent / attend reliably
Certain medications:
b-blocker (e.g propranolol)
ACE inhibitor (e.g. ramapril)
Some antidepressants
Some immune system disorders and cancers

12. Where can I go for VIT?