The clinical and cost-effectiveness of Pharmalgen® for the treatment of bee and wasp venom allergy
1 TITLE OF PROJECT
The clinical and cost effectiveness of Pharmalgen® for the treatment of bee and wasp venom allergy
2 TAR TEAM
Liverpool Reviews and Implementation Group (LRiG), University of Liverpool 世风
Correspondence to:
Rumona Dickson, Ms
Director, LRiG
carelessUniversity of Liverpool
Room 2.12
Whelan Building
meadeThe Quadrangle
Brownlow Hill
Liverpool
L69 3GB
Tel: +44 (0) 151 794 5682
Fax: +44 (0)151 794 5585
Email: ****************.uk
For details of experti within the TAR team, e ction 7.
3 PLAIN ENGLISH SUMMARY
Allergic reactions to bee and wasp venom may occur in venom-nsitive patients immediately following a sting, and can vary in verity, with initially mild symptoms sometimes progressing to critical conditions within conds. The most vere systemic allergic reactions (generalid reactions) are known as anaphylaxis, a reaction characterid by abnormally low blood pressure, fainting or collap, and in extreme reactions the symptoms can cau death.
Each year in the UK there are between two and nine deaths from anaphylaxis caud by bee and wasp venom. The immediate treatment for vere allergic reactions to bee and wasp venom consists of emergency treatment with drugs to decrea the patient’s respon to the venom and support breathing, if required.
To avoid further reactions, the u of nsitisation to bee and wasp venom, through a process known as venom immunotherapy (VIT), has been investigated. Venom immunotherapy consists of subcutaneous injections of increasing amounts of venom into patients with a history of anaphylaxis to bee and wasp venom. Pharmalgen® has had UK
marketing authorisation for the diagnosis and treatment (using VIT) of allergy to bee venom (using Pharmalgen® Bee Venom) and wasp venom (using Pharmalgen® Wasp Venom) since March 1995, and it is ud by more than 40 centres across the UK. This review aims to asss whether using Pharmalgen® in VIT is clinically uful when treating people with a history of vere reaction to bee and wasp stings. The review will compare preventative treatment with Pharmalgen® to other treatment options, including high do antihistamines, advice on the avoidance of bee and wasp stings and adrenaline auto-injector prescription and training. If suitable data are available, the review will also consider the cost effectiveness of using Pharmalgen® for VIT and other subgroups including children and people at high risk of future stings or vere allergic reactions to future stings.
4 DECISION PROBLEM
4.1 Clarification of rearch question and scope
Pharmalgenindependent是什么意思® is ud for the diagnosis and treatment of immunoglobin E (IgE)-mediated
allergy to bee and wasp venom. The aim of this report is to asss whether the u of Pharmalgen® is of clinical value when providing VIT to individuals with a history of vere reaction to bee and wasp venom and whether doing so would be considered cost effective compared with alternative treatment options available in the NHS.
4.2 trebleBackground
2016高考分数查询Bees and wasps form part of the order Hymenoptera (which also includes ants), and within this order the species that cau the most frequent allergic reactions are the Vespidae (wasps, yellow jackets and hornets), and the Apinae (honeybees).1
redhotBee and wasp stings contain allergenic proteins. In wasps, the are predominantly phospholipa A1,2 hyaluronida2 and antigen 5,3 and in bees are phospholipa A2 and hyaluronida.4 Following an initial sting, a type 1 hypernsitivity reaction may occur in some individuals which produces the IgE antibody. This nsitis cells to the allergen, and any subquent exposure to the allergen may cau the allergen to bind to the IgE molecules, which results in an allergic reaction.
The allergens typically produce an inten, burning pain followed by erythema (redness) and a small area of oedema (swelling) at the site of the sting. The symptoms produced following a sting can be classified into non-allergic reactions, such as local reactions, and allergic reactions, such as extensive local reactions, anaphylactic systemic reactions and delayed systemic reactions.5-6 Systemic allergic reactions may occur in venom-nsitive patients immediately following a sting,7 and can vary in verity, with initially mild symptoms sometimes progressing to critical conditions within conds.1
The most vere systemic allergic reaction is known as anaphylaxis. Anaphylactic reactions are of rapid ont (typically up to 15 minutes post sting) and can manifest in different ways. Initial symptoms are usually cutaneous followed by hypotension, with light-headedness, fainting or collap. Some people develop respiratory symptoms due to an asthma-like respon or laryngeal oedema. In vere reactions, hypotension, circulatory disturbances, and breathing difficulty can progress to fatal cardio-respiratory arrest.
wearing是什么意思
Anaphylaxis occurs more commonly in males and in people under 20 years of age and can be vere and potentially fatal.8
4.3 Epidemiology
It is estimated that the prevalence of wasp and bee sting allergy is between 0.4% and 3.3%.9 The incidence of systemic reactions to wasp and bee venom is not reliably known, but estimates range from 0.15-3.3%,with用法10-11 lily英语Systemic allergic reactions are reported by up to 3% of adults, and almost 1% of children have a medical history of vere sting reactions.9, 12 After a large local reaction, 5–15% of people will go on to develop a systemic reaction when next stung.13 In people with a mild systemic reaction, the risk of subquent systemic reactions is thought to be about 18%.13 Hymenoptera venom are one of the three main caus of fatal anaphylaxis in the USA and UK.14-15 Inct stings are the cond most frequent cau of anaphylaxis outside of medical ttings.16 Between two and nine people in the UK die each year as a result of anaphylaxis due to reactions to wasp and bee stings.17 Once an individual has experienc
ed an anaphylactic reaction, the risk of having a recurrent episode has been estimated to be between 60% and 79%.13
