Rapid venom immunotherapy update

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Abstract
This paper will review new indications for the administration of rapid or ultrarush venom immunotherapy and the advantages of pretreatment with antihistamines. Rapid and ultrarush venom immunotherapy protocols have been successfully employed to achieve protective maintenance venom doses rapidly. These have been associated with systemic reactor rates as low as 5-7%. Recently, rapid venom immunotherapy protocols have been successfully employed to reach ultra-high maintenance doses for patients not previously protected with standard maintenance doses (i.e. 100 micro g). There is also evidence that pretreatment with antihistamines before venom injections during rapid venom immunotherapy may reduce the numbers and severity of injection-related systemic reactions, as well as improve long-term outcomes in preventing subsequent resting systemic reactions in the field. Pretreatment with antihistamines should be considered in patients receiving rapid or ultrarush venom injections. Ultrarush or rapid immunotherapy regimens compare favorably with conventional modified rush protocols in terms of side-effects, and may be considered in order to achieve higher but effective maintenance venom doses in those rare patients who are treatment failures.