Supplementary Material for: Long-Term Follow-Up of Children after Venom Immunotherapy: Low Adherence to Anaphylaxis Guidelines

Background: Data on the long-term outcome of children
after specific venom immunotherapy (VIT) are limited. Therefore, we
assessed sting recurrence and anaphylaxis relapse rates as well as
adherence to anaphylaxis guidelines with regard to the availability of
emergency equipment and education status. Methods: For
this long-term survey, data of 311 children with a history of
anaphylactic reactions to hymenoptera stings were collected by chart
review. We included patients who were treated with a 3-year VIT between
1993 and 2009 and had completed a questionnaire. Results:
Forty of the 311 patients were included. Mean VIT duration was 3.1
years. Of the 40 patients included, 29 children (72.5%) received VIT
with vespid venom, 9 with bee venom, and 2 patients with both venoms.
During a mean follow-up period of 13 years, 20/40 patients (50%)
suffered re-stings. Six of the 20 (30%) patients developed again
anaphylactic symptoms (grade 1 n = 5, grade 3 n = 1); 2
were allergic to vespid and 4 to bee venom. Of the entire cohort, only
5/40 (12.5%) had appropriate emergency kits according to the guidelines
of the European Academy of Allergy and Clinical Immunology. Among the
patients who had emergency kits available, one third (5/15) felt
uncertain about the correct application of the medication. Less than two
thirds of our population (25/40) affirmed that they have been educated
in emergency management. The vast majority (95%; 38/40) of our patients
did not have allergy follow-ups after VIT completion. Conclusions:
Anaphylactic relapses are not uncommon, and there are considerable
deficits in the emergency management of patients. Hence, comprehensive
standardized anaphylaxis education programs as well as regular
follow-ups of the allergy status are crucial.