Venom immunotherapy

This resource is for parents or carers of children with a diagnosed venom allergy and who are considering undergoing venom immunotherapy.

What is venom immunotherapy?

Most allergies are due to an over reaction of the immune system to foreign material, such as bee or wasp venom, pollens, or animal dander. Venom immunotherapy (also known as desensitization) is a treatment in which increasing doses venom are given in order to improve the body’s tolerance in case the individual has another sting.

What does the treatment involve?

Different amounts of venom will be injected just below the surface of your child’s skin.

To start with we build up your tolerance by giving increasing amounts of allergen over a specific period according to your schedule.

Afterwards we give a maintenance dose as a 4 to 8 weekly injection for up to 3 years.

These injections are timed at specific intervals and it is extremely important that you or your child attend each visit unless they are unwell.

At each visit the doctor will record details of your preceding injection and symptoms you may have had. After each injection your child must be stay in the clinic for at least 1 hour to check that they are well enough. If they feel unwell after the injection, they may need to stay a little longer until the doctor is happy for you to leave.

What is the response to the treatment?

The vast majority of people having venom immunotherapy will be completely protected from future stings for up to 10 to 20 years.

However, there is still about a 5 percent chance of having an allergic reaction next time your child is stung. This is particularly if they are stung by multiple stinging insects at the same time.

Children with bee or wasp sting allergies should still carry their adrenaline auto-injector (Epipen, Jext or Emerade) at all times.

Are there any side effects to the treatment?

After the injection a small local reaction will sometimes appear in the form of a swelling with redness. In some cases the swelling may be quite large and may even be accompanied by nose or chest symptoms.

These will usually settle on their own or with an antihistamine (if your child is not already taking them) but if you are concerned you should not hesitate to contact the paediatric allergy consultant.

Delayed symptoms such as localised swelling or itching will usually settle on their own. If the symptoms are troublesome, you can give them an extra dose of antihistamine can be given.

If their skin is very itchy, you can give them a steroid cream such as 1 percent hydrocortisone. If you are concerned for your child, not hesitate to contact the paediatric allergy consultant.

Local reactions are not a reason to discontinue the treatment, but some adjustment will be made to the dosage. Rarely, small nodules may appear under the skin at the site of the injection. These are nothing serious and do not mean treatment needs to be stopped.

Serious reactions to immunotherapy are very rare but can occur during the first 30 to 60 minutes following the injection. In the past, rare deaths have occurred due to serious systemic reactions that were not treated promptly. This is why we ask you to stay for 60 minutes after each injection. The medical staff in the clinic are experienced in treating this sort of reaction and will deal help your child if they need treatment.

Is there anything that I should not do after my child’s injection?

During the 24 hours after the injection, your child must avoid any form of strenuous physical exercise, prolonged hot bathing and alcohol. These activities can increase the risk of delayed reactions.

What should I do if my child develops a new illness or is put on a new drug?

You should inform the paediatric allergy consultant if your child has a new illness or if you have started a new medication. Sometimes they may need to stop immunotherapy treatment.

Injections should not be given at the same time as vaccinations. We usually recommend leaving 2 weeks between vaccinations and immunotherapy injections. Injections are also not recommended during ‘colds’ or chest infections. If in doubt, please speak to the nurse or the doctor at the immunotherapy clinic.

We will not start immunotherapy if your child is already pregnant. However, if they become pregnant whilst already on a well established maintenance regime, treatment can be continued. This should discussed with your child’s doctor since there is still a small but real risk of having a severe allergic reaction during treatment and this might affect the baby’s health.