Immunotherapy Improves Health-related Quality of Life of Adult Patients with Dermal Reactions Following Yellow Jacket Stings

Background: In many European centers insect venom allergic patients with a reaction confined to the skin are only offered an epinephrine auto-injector and not venom immunotherapy (VIT). Previously we showed that VIT improves health-related quality of life (HRQL) of yellow jacket allergic patients with more than dermal reactions.

Objective: To examine whether HRQL of dermal reactors is impaired and to examine the influence of VIT on HRQL in comparison with the EpiPen.

Methods: Patients with solely dermal reactions were asked if they were willing to be randomized either to VIT or EpiPen, after receiving patient information. Before and 1 year after enrollment, patients completed the Vespid allergy Quality of Life Questionnaire (VQLQ), Burden of Treatment and Expectation of Outcome.

Results: Of 55 patients eligible for the study, 29 consented to randomization: 15 to VIT, 14 to EpiPen. The remaining 26 patients preferred to choose their treatment: 11 VIT and 15 EpiPen. The VQLQ score of patients randomized to VIT improved (mean change 0.83 (SD 0.87), in contrast to patients randomized to the EpiPen whose scores deteriorated (mean change -0.42 (SD 0.64), P < 0.0001), resulting in an overall difference of 1.25 [95% confidence interval (CI): 0.63-1.87]. With a minimal important difference of 0.5 indicating a clinically significant improvement, VIT generated an number needed to treat (NNT) of 1.7. Dermal reactors did not consider VIT burdensome and rated this treatment as being superior to the EpiPen.

Conclusion: VIT results in a clinically significant improvement of HRQL in most patients with reactions limited to the skin following yellow jacket stings. Prescription of an EpiPen in patients not choosing this treatment is associated with deterioration in HRQL and should therefore be avoided as definitive treatment in these patients.