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Have a history of anaphylaxis or are receiving specific allergen immunotherapy. The authors recently reported a patient who died of ventricular fibrillation during Vespula venom immunotherapy VIT ; after her BB therapy was withdrawn. The safety and outcomes of continuing BB treatment during Hymenoptera VIT were analyzed. Of 1, 389 patients for whom Hymenoptera VIT was recommended, 11.2% either had cardiovascular disease or were taking BBs. Mean age in this subgroup was 53 years, compared to 35 years in the overall experience. In most patients who were taking BBs before VIT, the medication was replaced by another drug. However, the risks of stopping BB treatment were considered too high in 4 patients, while another 9 were restarted on BBs after reaching their maintenance dose. Another 12 patients started BB therapy during VIT. Among the 25 patients taking BBs during VIT, the rate of allergic side effects during VIT was just 3%. This was nonsignificantly lower than the 16.7% rate among patients with cardiovascular disease who were not taking BBs. For patients re-exposed to Hymenoptera stings after VIT, systemic allergic symptoms developed in 14.3% of those who received BBs during treatment and 13.8% of those who did not. A significant percentage of patients receiving Hymenoptera VIT have cardiovascular disease and or are receiving BBs. This retrospective study suggests that, at least in some patients, BB therapy can be safely continued during VIT. The authors believe that the contraindication for BB treatment during VIT should be considered relative rather than absolute. COMMENT: These Swiss researchers analyzed their venom-allergic patients to determine the risk of concomitant use of beta-blockade with VIT. Of the 1, 398 patients in their institution who received VIT, 11.2% had cardiovascular disease. A total of 25 patients ended up receiving BB and VIT simultaneously. Interestingly, the percentage of patients having systemic allergic reactions to both VIT and repeat stings was similar in patients either with or without BB. The Practice Parameters state that BB therapy should be considered a relative contraindication for immunotherapy. These data suggest that BB should not be withheld in our venom-allergic patients with cardiovascular disease. S. M. F. Mller UR, Haeberli G: Use of beta-blockers during immunotherapy for Hymenoptera venom allergy. J Allergy Clin Immunol. 2005; 15: 606-610.
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