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β-blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy
  • +36
  • Gunter Sturm,
  • Sereina Herzog,
  • Werner Aberer,
  • Teresa Alfaya Arias,
  • Dario Antolin-Amerigo,
  • Patrizia Bonadonna,
  • Elisa Boni,
  • Andrzej Bozek,
  • Marta Chełmińska,
  • Barbara Ernst,
  • Nina Frelih,
  • Radoslaw Gawlik,
  • Asli Gelincik,
  • Thomas Hawranek,
  • Wolfram Hötzenecker,
  • Aránzazu Jiménez Blanco,
  • Karolina Kita,
  • Reşat Kendirlinan,
  • Mitja Kosnik,
  • Karin Laipold,
  • Roland Lang,
  • Francesco Marchi,
  • Marina Mauro,
  • Marita Nittner-Marszalska,
  • Iwona Poziomkowska-Gesicka,
  • Valerio Pravettoni,
  • Donatella Prezioso,
  • Oliviero Quercia,
  • Norbert Reider,
  • Marta Rosiek-Biegus,
  • Berta Ruiz,
  • Christoph Schrautzer,
  • Pilar Serrano,
  • Aytul Sin,
  • Betül Sin,
  • Johanna Stoevesandt,
  • Axel Trautmann,
  • Martina Vachová,
  • Lisa Arzt-Gradwohl
Gunter Sturm
Medical University of Graz

Corresponding Author:gunter.sturm@medunigraz.at

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Sereina Herzog
University of Antwerp
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Werner Aberer
Medical University of Graz
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Teresa Alfaya Arias
Hospital General Universitario de Ciudad Real
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Dario Antolin-Amerigo
Hospital Universitario Principe de Asturias
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Patrizia Bonadonna
Verona General Hospital
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Elisa Boni
Maggiore Hospital
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Andrzej Bozek
Medical University of Silesia
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Marta Chełmińska
Medical University of Gdansk
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Barbara Ernst
General Hospital Ordensklinikum Linz GmbH Elisabethinen
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Nina Frelih
University Clinic of Respiratory and Allergic Diseases Golnik
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Radoslaw Gawlik
Silesian University of Medicine
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Asli Gelincik
Istanbul University
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Thomas Hawranek
Paracelsus Medical University Salzburg
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Wolfram Hötzenecker
Johannes Kepler University Linz
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Aránzazu Jiménez Blanco
Alfonso X El Sabio University
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Karolina Kita
Medical University of Gdańsk
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Reşat Kendirlinan
Ankara University
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Mitja Kosnik
University Clinic of Respiratory and Allergic Diseases Golnik
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Karin Laipold
Medical University of Graz
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Roland Lang
Paracelsus Medical University Salzburg
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Francesco Marchi
Azienda Ospedaliero Universitaria Pisana
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Marina Mauro
Sant'Anna Hospital
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Marita Nittner-Marszalska
Medical University of Wroclaw
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Iwona Poziomkowska-Gesicka
Pomeranian Medical University in Szczecin
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Valerio Pravettoni
IRCCS Foudation Ca’ Granda Ospedale Maggiore Policlinico
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Donatella Prezioso
Sant'Anna Hospital
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Oliviero Quercia
Hospital of Faenza
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Norbert Reider
Medical University of Innsbruck
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Marta Rosiek-Biegus
Medical University of Wroclaw
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Berta Ruiz
Maimonides Biomedical Research Institute of Cordoba (IMIBIC)
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Christoph Schrautzer
Medical University of Graz
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Pilar Serrano
Maimonides Biomedical Research Institute of Cordoba (IMIBIC)
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Aytul Sin
Ege University
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Betül Sin
Ankara University
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Johanna Stoevesandt
University Hospital Würzburg
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Axel Trautmann
University Hospital Würzburg
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Martina Vachová
Charles University
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Lisa Arzt-Gradwohl
Medical University of Graz
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Abstract

Background: There is controversy whether taking β-blockers or ACE inhibitors (ACEI) is a risk factor for more severe systemic insect sting reactions (SSR) and whether it increases the number or severity of adverse events (AE) during venom immunotherapy (VIT). Methods: In this open, prospective, observational, multicenter trial, we recruited patients with a history of a SSR and indication for VIT. The primary objective of this study was to evaluate whether patients taking β-blockers or ACEI show more systemic AE during VIT compared to patients without such treatment. Results: In total, 1,425 patients were enrolled and VIT was performed in 1,342 patients. Of all patients included, 388 (27.2%) took antihypertensive (AHT) drugs (10.4% took β-blockers, 11.9% ACEI, 5.0% β-blockers and ACEI). Only 5.6% of patients under AHT treatment experienced systemic AE during VIT as compared with 7.4% of patients without these drugs (OR: 0.74, 95% CI: 0.43–1.22, p=0.25). The severity of the initial sting reaction was not affected by the intake of β-blockers or ACEI (OR: 1.14, 95% CI: 0.89–1.46, p=0.29). In total, 210 (17.7%) patients were re-stung during VIT and 191 (91.0%) tolerated the sting without systemic symptoms. Of the 19 patients with VIT treatment failure, 4 took β-blockers, none an ACEI. Conclusions: This trial provides robust evidence that taking β-blockers or ACEI does neither increase the frequency of systemic AE during VIT nor aggravate SSR. Moreover, results suggest that these drugs do not impair effectiveness of VIT. (Funded by Medical University of Graz, Austria; Clinicaltrials.gov number, NCT04269629)
18 Nov 2020Submitted to Allergy
19 Nov 2020Submission Checks Completed
19 Nov 2020Assigned to Editor
19 Nov 2020Reviewer(s) Assigned
02 Dec 2020Review(s) Completed, Editorial Evaluation Pending
03 Dec 2020Editorial Decision: Revise Minor
06 Jan 20211st Revision Received
06 Jan 2021Submission Checks Completed
06 Jan 2021Assigned to Editor
06 Jan 2021Reviewer(s) Assigned
19 Jan 2021Review(s) Completed, Editorial Evaluation Pending
20 Jan 2021Editorial Decision: Accept
Jul 2021Published in Allergy volume 76 issue 7 on pages 2166-2176. 10.1111/all.14785