Honeybee venom immunotherapy: An Australian center experience of more than 15 years

BACKGROUND: Honeybee venom is a leading cause of anaphylaxis, and venom immunotherapy (VIT) reduces the risk of future severe reactions to stings. OBJECTIVE: To retrospectively evaluate treatment practices and outcomes of honeybee VIT (HB-VIT) in an Australian center. METHODS: Patients who underwent HB-VIT between July 2010 and July 2025 were identified, and data on demographics, Brown anaphylaxis grade, tryptase level, specific IgE, HB-VIT protocol (ultra-rush [UR] or semi-rush [SR], adverse reactions [AR], and field sting reactions during and after HB-VIT) were recorded. RESULTS: A total of 167 patients received HB-VIT; most of them were of male gender (n = 126, 75.4%), with a median age of 48 years (IQR, 36.0-59.0). Most patients had Brown grade 2 (n = 86, 51.5%) or 3 (n = 71, 42.5%) anaphylaxis at the index reaction. There were 3 patients who had indolent systemic mastocytosis. A total of 99 patients (59.3%) had the SR protocol. THE UR was more common than SR among those from regional or rural residence (48 vs 18; P < .05). Of the 87 allergic ARs in 58 patients (34.7%), all occurred during HB-VIT buildup; large, localized reactions were most frequent (n = 25, 15.0%). There were 10 patients (6%) who developed systemic allergic reactions. Omalizumab was prescribed and was successful in preventing further systemic allergic reactions in 2 of these patients (1 with indolent systemic mastocytosis). There were no significant differences in frequency and severity of ARs between protocols. A total of 30 patients experienced field stings during or after HB-VIT completion; 3 (10%) developed systemic allergic reactions (n = 3). CONCLUSION: This retrospective study demonstrates the effectiveness of HB-VIT and the tolerability of both SR and UR protocols.