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M D Valentine

Publications and source records attributed to M D Valentine.

At least 37 records · Page 2Linked to original sources
PubMed1984

Insect venom allergy: diagnosis and treatment.

Allergy to insect venom is IgE mediated. Untreated, it occasionally terminates fatally and often causes temporary illness. Medical intervention with venom immunotherapy in patients with prior systemic reactions presents reactions to stings by inducing IgG-antibody formation, although in some groups of patients this results in little real benefit. Emergency self-treatment kits (Epi-Pen and Epi-Pen Jr., Center Laboratories, Port Washington, N.Y.; Ana Kit, Hollister-Stier, Spokane, Wash.), if promptly and intelligently used, may reverse most moderate sting reactions. Some severe reactions require aggressive therapy. Until better treatment criteria are available, the most certain way of reducing the risk of systemic reactions to stings is with venom immunotherapy.

Acute Disease↗
PubMed1984

The development of negative skin tests in children treated with venom immunotherapy.

Twenty-eight of 62 children (45%) with a history of sting-induced anaphylaxis and initially positive skin tests to venom(s) developed negative venom skin tests to one or more of the venoms used in their treatment after 3 yr or more of immunotherapy. Children who developed negative venom skin tests were less sensitive prior to treatment, as judged by venom skin tests and venom-specific IgE antibody determinations, than children who maintained positive venom skin tests. Levels of venom-specific IgE antibodies declined with time in most children, but to lower levels in those with negative skin tests. Venom-specific IgG antibody levels were similar in both patients with negative skin tests and those with persistently positive skin tests. The development of negative skin tests may reflect a loss of allergic sensitivity, which is sufficient to allow the physician to consider the discontinuation of venom injections.

Adolescent↗
PubMed1984

A prospective study of the natural history of large local reactions after Hymenoptera stings in children.

Large local reactions are a frequent occurrence after insect stings. We prospectively studied the demography, immunology, and significance of these reactions in the pediatric age group. Most children (83%) who have had large local reactions have positive skin test results to one or more venoms. Elevated amounts of venom-specific IgE antibody are usually present. Over 3 to 5 years, allergic sensitivity declines, as evidenced by less positive skin test results and lower levels of antivenom IgE antibodies. Most significantly, of 113 repeat stings, only 2% resulted in a systemic reaction.

Adolescent↗
PubMed1983

Epidemiologic study of insect allergy in children. II. Effect of accidental stings in allergic children.

One hundred eighty-one children with non-life-threatening reactions to insect stings and positive venom skin tests were randomized to treatment (53) or no-treatment (128) groups and followed up clinically and immunologically for at least two years to assess the results of accidental stings. Twenty-eight stings in 17 treated patients and 74 stings in 47 untreated children occurred, leading to one mild reaction in a treated patient, and eight in the no-treatment group (P = NS). No reaction was more serious than the original. Based on IgE antibody changes and skin test results, 87% of the untreated children were stung by an insect to which they had clinical sensitivity by skin test. Vespid skin test sensitivity decreased 10-fold or more in both treated (72%) and untreated (44%) children. Of those with increased sensitivity, congruent to 70% had been stung. These data indicate that the incidence of severe reactions on resting is low in insect-allergic children, and that the majority show decreased skin test sensitivity over time.

Adolescent↗
PubMed1982

Clinical relevance of the venom-specific immunoglobulin G antibody level during immunotherapy.

Parameters associated with successful venom immunotherapy in insect allergy were sought by comparison of treatment failures with successes. Half-dose treatment was completely protective in 32 patients (successes) but was only partially effective in eight (failures). The outcome of treatment was not related to the severity of pretreatment sting reactions, to the degree of skin-test sensitivity, to an atopic personal history, or to age or gender. The mean yellow jacket venom-specific IgG antibody level (by the Staph-A solid-phase radioimmunoassay) was significantly less in the failures (3.9 +/- 0.6 microgram/ml) than in the successes (7.3 +/- 1.1 microgram/ml) (p less than 0.01). When the failures were successfully treated, their mean IgG level (6.1 +/- 1.3 microgram/ml) was significantly greater than that associated with treatment failure (p less than 0.025). Patients with an IgG antibody level above 5.0 microgram/ml were significantly more likely to be fully protected (p less than 0.02). Those whose IgG levels were less than 5 microgram/ml had a risk of reaction similar to that in untreated patients. We conclude that early in the maintenance phase of low-dose venom immunotherapy, the risk of a reaction to a challenge sting is significantly greater for those patients with low levels of venom-specific IgG antibodies.

Animals↗
PubMed1982

An epidemiologic study of insect allergy in children. I. Characteristics of the disease.

Of 235 children with a history of allergic reactions to insect stings studied, 59 had severe life-threatening systemic reactions, 123 had mild, non-life-threatening systemic reactions, and 53 had large local reactions. The overall male-female ratio was 2:1. Venom skin tests were positive in approximately 89% of each group. Prior whole body extract therapy increased the likelihood of venom skin test reactivity to multiple insect venoms from 51 to 78%. Venom skin test results did not correlate with the severity of previous allergic reactions. One hundred and nine children with NLTR and positive venom skin tests were entered into one of two groups--venom immunotherapy or observation only. During the first six months the treatment group had the expected fourfold rise in venom-specific IgE antibody titers, whereas the observation group had a decline of the mean IgE titer. Patients in the observation group who were accidentally stung had a transient rise in IgE antibody titers. The small number of accidental stings which occurred in both groups resulted in reactions milder than the original reactions. Although based on preliminary data, venom immunotherapy may not be necessary for some children with previously mild systemic symptoms.

Adolescent↗
PubMed1981

Treatment failures with whole-body extract therapy of insect sting allergy.

Whole-body extracts (WBEs) remain in widespread use for therapy of insect sting anaphylaxis two years after the approval of Hymenoptera venoms. We have reviewed our experience with WBEs in our patient population. Of 250 patients who received WBE, 115 had subsequent stings. Systemic allergic reactions occurred in 65% large local reactions in 23%, and no reaction in 12%. There was no consistent change in the severity of systemic reactions during WBE treatment. Systemic reaction occurred less commonly in younger persons or after at least two years of WBE treatment. We conclude that WBE is not effective for the prevention of allergic insect sting reactions. The natural history of the disease may account for its apparent efficacy in young people or those having prolonged WBE therapy. Venom immunotherapy is safe and rapidly effective and is the only protective treatment recommended.

Adolescent↗
PubMed1981

Dose dependence of Hymenoptera venom immunotherapy.

The clinical and immunologic efficacy of venom immunotherapy up to 50 micrograms maintenance doses (half the recommended dose) was examined in 23 patients with anaphylactic sensitivity to insect stings and is compared with that in two groups of patients treated with the full 100-micrograms recommended dose. Four of the 19 patients challenged with insect stings had mild systemic reactions not requiring treatment. This 79% clinical efficacy is significantly less than the 96% to 100% success achieved with treatment to full 100-micrograms maintenance doses. The venom-specific IgG antibody response to the 50-micrograms dose reached a level significantly lower than observed with 100 micrograms doses. We conclude that the clinical and immunologic responses to venom immunotherapy are dose dependent and are more reliably complete at the recommended maintenance dose of 100 micrograms of each venom than at a dose of 50 micrograms.

Bee Venoms↗
PubMed1981

Prolonged maintenance interval in hymenoptera venom immunotherapy.

To decrease the cost, inconvenience, and potential side effects of venom immunotherapy we tested whether the interval between the maintenance injections can be increased. In 30 patients who had been given the standard therapy regimen and who had been sting-challenged after 1 and 2 yr of monthly maintenance injections the maintenance interval was increased from 4 to 6 wk. IgG anti-yellow jacket venom antibodies did not change over the next 9 mo. The incidence of local reactions to venom injections did not increase, and there were no systemic reactions during therapy. After 6 to 9 mo 29 of the 30 patients were sting-challenged with one possible reaction. The success rate, 97%, is the same as that observed with monthly maintenance injections. We conclude that the 6-wk maintenance interval is effective in both clinical and immunologic terms after a period of monthly maintenance therapy.

Arthropod Venoms↗
PubMed1980

A controlled study of the effectiveness of the Rinkel method of immunotherapy for ragweed pollen hay fever.

In a double-blind study, we compared the effects of the Rinkel method of immunotherapy with ragweed pollen extract and placebo on symptoms of ragweed hay fever and immunologic parameters in 24 ragweed-sensitive patients. Each had a skin-test end point by Rinkel serial dilution titration to ragweed pollen extract at 1:312,500 w/v or greater dilution, a 2 + skin test to ragweed AgE at 0.1 microgram /ml or greater dilution, and in vitro leukocyte histamine release by ragweed pollen extract. None had had immunotherapy for at least 7 yr. Patients matched on the basis of leukocyte histamine release by ragweed were assigned to two treatment groups (12 patients in each group). One group received ragweed pollen extract, and the other, placebo, both administered by the Rinkel method between June and October, 1978. Treatment doses were derived from skin-test end points. The median maintenance ("optimal dose") for patients receiving ragweed pollen extract was 0.53 ml of 1:312,500 w/v and the mean cumulative dose of ragweed pollen extract given during the study contained 0.094 micrograms of ragweed AgE. Symptom-medication scores of all patients rose and fell with ragweed pollen counts. No significant differences were observed in mean daily symptom-medication scores, antiragweed IgG or IgE levels, leukocyte histamine release by ragweed, total IgE levels, or skin-test end-point dilutions with ragweed pollen extract between the group receiving ragweed pollen extract and the group receiving placebo. Despite the absence of specific effect on symptom-medication scores and measured immunologic variates, 10 3f the 12 ragweed-treated patients and 10 of the 12 placebo-treated patients were of the opinion that their hay fever symptoms during the ragweed pollen season were less severe in 1978 than in 1977 and that they had been helped by Rinkel method immunotherapy. Under the conditions of the study, Rinkel method immunotherapy with ragweed pollen extract was no more effective than placebo given in an imitation of the Rinkel method.

Adolescent↗
PubMed1980

Diagnosis and treatment of anaphylactic reactions to Hymenoptera stings in children.

Forty-four children (mean age 9.6 years) with a history of an allergic reaction(s) to an insect sting and with positive insect venom skin tests were studied. IgE antibodies (RAST) to honeybee phospholipase A and to yellow jacket venom were found in the sera of 78% and 77%, respectively, of these patients. The patients were immunized with the appropriate venoms over a 15-week course and most were then subjected to an in-hospital sting; there was a 3% reaction rate (1/37). Clinical protection as associated with a fivefold increase in anti-venom IgG. Five patients did not develop a significant increase in IgG antibody and they were treated more vigorously; four were stung subsequently without reaction. Two patients did not react when stung in the field; positive identification of the culprit insect was obtained. Twenty patients were re-stung after one year of maintenance therapy; there was a single mild, delayed reaction. Immunotherapy also increased the IgE antibody against venom 3.7-fold at three months; after one year of therapy the IgE antibody level had decreased but was still 40% greater than at the outset. Immunotherapy was associated with a 25% incidence of local pain and swelling and a 6% incidence of systemic reactions. We conclude that venom therapy in children is safe and effective. The indications for initiating immunotherapy require further definition.

Adolescent↗
PubMed1980

Physiologic manifestations of human anaphylaxis.

In the course of a controlled study to evaluate different forms of immunotherapy for subjects with insect-sting hypersensitivity, we observed 11 subjects who had systemic cutaneous urticarial reactions and 3 subjects who experienced systemic anaphylaxis. With the exception of tachycardia, there were no cardiopulmonary changes in the subjects with urticaria, whereas the major manifestation of anaphylactic shock in the other three subjects was severe hypotension that was probably secondary to peripheral vasodilation. Significant abnormalities in gas exchange developed in two subjects. In one, bronchospasm precipitated a respiratory arrest followed by endotracheal intubation with mechanical ventilation. Although plasma histamine levels were not related to the development of cutaneous reactions, the plasma histamine levels correlated with the severity and duration of the cardiopulmonary changes observed during anaphylactic shock. The two subjects with the most severe shock showed evidence of intravascular coagulation characterized by a diminution of Factor V, Factor VIII, fibrinogen, and high molecular weight kininogen, as well as changes in components of the complement system. Standard therapy with epinephrine and fluids, usually recommended for the treatment of systemic anaphylaxis, did not immediately reverse either the hemodynamic or the respiratory abnormalities in the two subjects with the most severe anaphylactic shock. Hemodynamic recovery was gradual and did not seem directly related to any specific therapeutic intervention.

Anaphylaxis↗
PubMed1980

Regimens of Hymenoptera venom immunotherapy.

We studied 64 sting-allergic patients treated with one of three regimens of insect-venom immunotherapy: slow, rush, or a step-function regimen. All regimens had a top dose of 100 micrograms and a similar cumulative dose. Efficacy was 100% in all regimens. Fifty percent of the patients had at least one large local reaction at a rate of 9.6 reactions/100 injections. Sixteen percent had systemic symptoms at 1.6 reactions/100 injections. Reaction rates did not differ among the groups, but the slow regimen involved twice as many injections as the rush regimen, and thus caused twice the number of reactions. The rush regimen caused a greater and more rapid rise in anti-venom IgG than did the slow regimen, with no difference in IgE levels. We conclude that although equally effective, the rush regimen of venom immunotherapy is associated with a greater immune response and fewer adverse reactions that the slow regimen.

Adult↗