Venom immunotherapy in children and adolescents: Efficacy and safety in an Italian tertiary allergy center.

BACKGROUND: Hymenoptera venom allergy (HVA) is a potentially life-threatening condition and the second most common cause of severe allergic reactions in children after food allergy. The risk of recurrence of systemic reaction is approximately 32% in untreated children; therefore, these patients need to undergo diagnostic tests and, if indicated, venom immunotherapy (VIT). However real-life data on VIT in children remain limited. METHODS: We conducted an observational study in a cohort of children and adolescents (n = 40) with HVA and treated with VIT in an Italian tertiary allergy center between 1999 and 2023. Data included demographic features, index reaction, pre-existing risk factors, timeline of VIT, adverse reactions to VIT, re-sting outcomes and serological exams were analyzed. RESULTS: The cohort was predominantly male (87.5%). Adverse reactions to VIT were infrequent, occurred mainly as local reactions, and showed low rates per injection. Among patients who completed ≥3 or ≥5 years of VIT, no severe systemic reactions were observed during treatment and epinephrine was never required. Re-stings during VIT were common, occurring up to 75.0%, mainly during the maintenance phase. Reactions were mild and limited to cutaneous symptoms. Among patients re-stung after completion of VIT (9/27 patients, 33%), no systemic reactions were observed and no epinephrine was required. Venom-specific IgE levels significantly decreased after completion of VIT (p = .004). CONCLUSIONS: The EAACI guidelines provide general recommendations for children, but many are based on limited pediatric evidence. This study provides additional data about the favorable safety profile and efficacy of VIT in children and adolescents with HVA.