Immunology - Patients undergoing Venom desensitisation

The aim of Immunotherapy (desensitisation) is to reduce your risk of a severe reaction (anaphylaxis) to a wasp or bee sting.
Increasing doses of injectable wasp or bee venom are given at regular intervals (starting with a very small dose).

Why Immunotherapy?

Venom Immunotherapy has been offered to you as you have previously sustained a severe reaction to either a wasp or bee sting and you are considered to still be at high risk of reactions due to stings.

How is treatment given?

Venom Immunotherapy is given by injection subcutaneously into your arm.

The dose of venom is gradually increased over a period of up to 4 months. This is the initial up-dosing phase of treatment. You will be asked to attend the hospital on our day unit for an injection every week during this phase.

Once the up-dosing phase is complete, we would expect you to have tolerated a large amount of venom. You will then go on to the maintenance phase of treatment which involves further injections every 6 to 8 weeks until completion of treatment. The total duration of Immunotherapy is usually 3 to 5 years.

How long will each visit take?

The venom injection only takes a few minutes to administer, but you will need to stay on the day unit following each injection for a 1-hour observation period in the event of any reaction.
 
Before the venom injection is administered and at each visit, you will have your peak respiratory flow measured by the Clinical Nurse Specialist. Peak flow is a measure of how quickly you can blow air out of your lungs (this is used to identify early signs of reaction).

The Clinical Nurse Specialist will then ask you a series of questions about your general health following your previous injection.
Once we are satisfied that you can go ahead with treatment, we will administer the injection.

You may experience some discomfort at the site of the injection (itching).

After the observation period, the nurse will re-check your peak flow and check the injection site. You will then be discharged.

Can the medications I take affect the treatment?

The Immunology consultant or Clinical Nurse Specialist will have noted all medications that you take during your consultation prior to treatment. However, if you have recently commenced on any new medications in particular the ones listed below please inform the Clinical Nurse Specialist.

• ACE Inhibitors (e.g., Ramipril, Lisinopril)
• Beta blockers (e.g., Propranolol, Bisoprolol)
• Antidepressants (e.g., Amitriptyline, Nortriptyline)
• Immunosuppressants or treatment for cancer

It is also important that you inform the nurses of any medication changes during your Immunotherapy treatment. Most medications can be continued during Immunotherapy, but the ones listed above may interact with medication that we may need to give in the event of a reaction.

Consent

The Immunology Consultant or Clinical Nurse Specialist will carry out consent before you start the treatment course. The consent will take place either at your clinic appointment or on the day of your first injection. During consent the treatment and the risks and benefits will be explained to you. You will also be given the opportunity to ask any questions.

What are the side effects?

Mild reactions are quite common and minor and tolerated well by most patients. An example of a mild reaction would be localised to the injection site and can become red, itchy, and slightly swollen; however, this can be easily treated by taking antihistamine tablets and/or cream. Mild local reactions are not a reason to discontinue treatment, but treatment may sometimes need dose adjustments.

Moderate/severe reactions are very rare and usually occur within the first 30 minutes following your injection. Symptoms of a more severe reaction are generalised itchy hives, wheezing and feeling faint due to a drop in blood pressure. These symptoms can be treated with emergency medications.

If you were to experience a moderate to severe reaction to the injection after leaving the hospital, we would advise you seek urgent medical attention and to use your adrenaline auto injector if needed.

What precautions are needed after an injection?

You may feel generally tired for up to 24 hours after the injection.

We advise that you avoid any form of strenuous physical activity for at least 24 hours following your injection, as these types of activities can make your body absorb the venom quicker and increase the risk of a delayed reaction.

What if you are unwell prior to your appointment?

If you are unwell with a cold, flu like symptoms or have a fever, we would ask that you let the immunology nurses know and we can postpone and rearrange your injection.

Having your injection and being unwell may put you at higher risk of reacting to the venom. Similarly, if you have other allergic symptoms, which have become worse recently; e.g. hay fever or asthma, the injection dose may be either reduced or delayed.

Any new symptoms that you are not sure about, please contact the Clinical Nurse Specialist before your appointment time.

Immunotherapy injections should not be given at the same time as other vaccines (for example: travel/flu vaccine).

We would recommend at least two weeks between your venom injection and any vaccination.

What if I miss an appointment?

It is important to attend the clinic every week during the initial phase and then every 6 to 8 weeks thereafter. If large intervals of injections are missed it may mean you have to re-start the treatment.

If you are unable to keep your appointment, please telephone the Clinical Nurse Specialists as soon as possible to rearrange.

Pregnancy

Immunotherapy is not recommended during pregnancy. If you were to become pregnant whilst on treatment, then unfortunately treatment will have to be stopped due to potential risks to the baby.

Do I have to carry my Adrenaline Pen?

Yes, you should continue to carry your adrenaline pen throughout the course of your Immunotherapy treatment. However, following completion of treatment this will be discussed with you.

Wasp/Bee sting avoidance measures

• Wear shoes that always cover your feet
• Avoid wearing brightly coloured clothing when outdoors
• Wear garments which fit close to your body. Insects can become trapped in loose-fitting clothing
• Avoid scented soaps, cosmetics, perfumes, and aftershaves
• Stay away from insect feeding grounds such as flower beds, fields of clover, rubbish and orchards with ripe fruit
• Keep car windows closed. Having open windows increases the risk of stings, but also potentially creating danger on the road due to insects arousing panic in a sting sensitive person
• Spray areas around rubbish with an effective insecticide
• Nests, hives, or mounds that house stinging insects should be destroyed by a professional exterminator. Contact your local council for information regarding services
• Don’t drink from uncovered cans/bottles
• Encourage people not to swat or annoy the insects
• Avoid bee keeping

Contact details

Queries about your condition or treatment
(Monday- Friday, 8am to 4pm excluding bank and public holidays)

Immunology/Allergy Clinical Nurse Specialist - 0161 206 5576 salfordimmunology.nurses@nca.nhs.uk

Administrative and appointment queries
(Monday – Friday, 9am to 3pm excluding bank and public holidays)

Immunology/Allergy Secretary – Jane Blaylock - 0161 206 0522

PALS (Patient Advice and Liaison Service)
(Monday – Friday, 08:30am to 4:30pm excluding bank and public holidays)
0161 206 2003

Patient Organisations

Allergy UK – www.allergyuk.org
Anaphylaxis Campaign – www.anaphylaxis.org.uk
Asthma UK – www.asthma.org.uk