This report describes patients who had late onset reactions following venom immunotherapy and
venom skin tests. Six adult patients had symptoms of
fatigue, malaise,
fever,
headache, and joint ache, starting four to six hours after venom immunotherapy and lasting up to four days. Two of the patients had prolonged reactions at or adjacent to the skin test sites. All of these patients had a history of
venom anaphylaxis; four had severe cardiovascular symptoms. All received yellow jacket venom immunotherapy and four
honeybee venom immunotherapy. In four patients, the reactions occurred following small
venom doses, 0.1 to 2 micrograms. Two patients reacted after maintenance doses of 50 micrograms. There was no relationship to the serum
IgE or
IgG antibody titers. All but one patient had serum
venom-specific
IgE but the titers covered a wide range. Serum
venom-specific
IgG was present in four patients. There was no response in lymphocyte culture to
bee venom stimulation in two patients. Two of these patients stopped venom immunotherapy; one had reached the maintenance dose. In three patients, prophylactic parenteral
steroids have ameliorated the reactions. After a temporary
dose reduction, the sixth patient is now asymptomatic. A seventh patient developed
asthma, 12 hours following a maintenance dose of 50 micrograms of yellow jacket
venom. Concomitant
steroid administration has effectively prevented the reaction. Another patient, a 6-year-old boy, developed
fever,
edema of the face and lips,
erythema of the leg, and a large, tender right inguinal node eight hours following
venom skin tests.(ABSTRACT TRUNCATED AT 250 WORDS)