Immunization in Wasp-Sting Allergy through Venom-Repositories and Periodic Insect Stings

Abstract

Summary and Conclusions Of 11 persons with alarming immediate reactions to polistes stings, 9 have been immunized with Arlacel:petrolatum:venom emulsions during 1960 and 1961, a total of 12 such annual treatments being given the group. For all but one member (BA), the repository was comprised of 1.2 ml containing all the venom of six live polistes workers, placed under the skin in a single injection (patient AT preferred a divided dose). There were no adverse effects either focally at the time of therapy or locally during the ensuing year or two. Seven of these members had been immunized, in one or more preceding years, with the same annual dose administered in fluid form during a one-visit, 2½-hr course that employed five to seven endermal injections. Five of their 19 treatments with fluid venom had, in contrast to the fully tolerated repositories, evoked borderline focal signs. In addition to these dually-treated patients, there was one physician who had tolerated five annual, 6-sac endermal courses of fluid venom, and another man who accepted uneventfully the full standard dose of venom in emulsified form. Repositories built up a satisfactory degree of immunity as judged by six planned and two accidental stings by one to three polistes inflicted on eight members at intervals as great as 7½ months after treatment. Only two trivial focal reactions were engendered. Resistance appeared to be equally good after the standard series of fluid venom injections, for there was only one trivial adverse development among 16 challenges that were made as soon as 13 days or as late as 41½ weeks after therapy. Emulsification decreased the venom's capacity to evoke local and focal responses. There were no cysts, abscesses, or new-growths at the repository sites. In an effort to provide year-round protection, 8 of the 11 members have, since their exhibition of tolerance toward stinging wasps, been transferred 2 to 21 weeks later to a regimen of intermittent stinging. Five trivial and one mild focal response have been engendered by 41 such sting treatments. The latter serve not only as probable booster stimuli but also as periodic tests of immunity.