Venom immunotherapy (VIT) is the gold-standard, potentially life-saving treatment for honeybee venom allergy, but for some patients, the buildup phase triggers severe allergic reactions (SARs), making it tough or impossible to continue.
A new retrospective study from Fiona Stanley Hospital in Perth, Western Australia, reviewed 350 adults on honeybee VIT between 2015 and 2024. About 16% experienced SARs during standard therapy, and 10% ultimately received the anti-IgE monoclonal antibody omalizumab as an add-on to improve tolerance.
Key predictors for needing omalizumab included:
- history of severe sting-induced anaphylaxis
- co-existing asthma
- elevated baseline tryptase levels (a marker often linked to mast cell issues)
Among the 35 patients who used omalizumab during the VIT dose escalation (uptitration), 63% successfully reached maintenance dose without ongoing omalizumab support. Another 20% stopped due to persistent SARs, and 14% continued on omalizumab.
The most effective and well-tolerated approach was a semi-rush protocol: omalizumab 300 mg loading dose 2 weeks before starting a 12-week VIT buildup to 100 μg, followed by 150 mg every two weeks until maintenance was achieved.
For patients with recurrent severe reactions during standard honeybee VIT, adjuvant omalizumab offers a valuable option to enable safe desensitization. This larger real-world dataset strengthens the case for considering it earlier in high-risk cases, potentially transforming outcomes for those at greatest risk from bee stings. Always discuss with an allergist, as protocols should be individualized.
References:
https://www.jaci-inpractice.org/article/S2213-2198(25)00935-3/fulltext