Subscribe to RSS
DOI: 10.1055/a-1660-4731
Wespe statt Biene – Akzidentelle Neusensibilisierung auf Wespengift unter Immuntherapie mit Bienengift
Wasp Instead of Bee – Accidental de novo Sensitization with Wasp Venom during Immunotherapy with Bee Venom![](https://www.thieme-connect.de/media/derma/202206/lookinside/thumbnails/229_10-1055-a-1660-4731-1.jpg)
Zusammenfassung
Während einer laufenden Immuntherapie mit Bienengift bei einer auf Bienengift monosensibilisierten Patientin wurde im 3. Jahr irrtümlicherweise eine Erhaltungsdosis Wespengift verabreicht. Es traten keine unmittelbaren Nebenwirkungen auf, hingegen konnte nach einigen Wochen ein Anstieg der initial negativen wespengiftspezifischen IgE- und IgG-Antikörper dokumentiert werden. Es muss somit von einer aktiven Sensibilisierung durch die hohe Einmaldosis Wespengift ausgegangen werden. Die Immuntherapie mit Bienengift konnte nach der empfohlenen Dauer von 5 Jahren vollendet werden. Eine akzidentelle nachweislich aktive Sensibilisierung auf ein Allergen ist sehr selten, dürfte aber einen Verstoß gegen die Pflichten aus dem Behandlungsvertrag darstellen und möglicherweise sogar den Tatbestand der Körperverletzung erfüllen. Die permanente Schädigung kann rechtlich schwerer wiegen als ein einmaliger Dosierungsfehler. Die strikte Anwendung von Leitlinienempfehlungen ist zur Vermeidung von systematischen und menschlichen Fehlern unabdingbar.
Abstract
In a patient monosensitized to bee venom, a maintenance dose of wasp venom was erroneously administered in the 3rd year during her ongoing immunotherapy with bee venom. There were no immediate side effects, but after a few weeks an increase of the initially negative wasp venom specific IgE and IgG antibodies could be documented. Thus, an active sensitization by the high single dose of wasp venom must be assumed. Immunotherapy with bee venom could be completed after the recommended duration of 5 years. Accidental demonstrable active sensitization to an allergen is very rare but is likely to constitute a breach of obligations under the treatment contract, and may even constitute a body injury. Permanent injury may be legally more serious than a one-time dosing error. Strict application of guideline recommendations is essential to avoid systematic and human errors.
Publication History
Article published online:
08 March 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Pfaar O, Bachert C, Bufe A. et al. Guideline on allergen-specific immunotherapy in IgE-mediated allergic diseases: S2k Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Society for Pediatric Allergy and Environmental Medicine (GPA), the Medical Association of German Allergologists (AeDA), the Austrian Society for Allergy and Immunology (ÖGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Dermatology (DDG), the German Society of Oto- Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Pneumology (GPP), the German Respiratory Society (DGP), the German Association of ENT Surgeons (BV-HNO), the Professional Federation of Paediatricians and Youth Doctors (BVKJ), the Federal Association of Pulmonologists (BDP) and the German Dermatologists Association (BVDD). Allergo J Int 2014; 23: 282-319 DOI: 10.1007/s40629-014-0032-2.
- 2 Aaronson DW, Gandhi TK. Incorrect allergy injections: allergistsʼ experiences and recommendations for prevention. J Allergy Clin Immunol 2004; 113: 1117-1121 DOI: 10.1016/j.jaci.2004.01.756.
- 3 Patel S, Rossow KL, Williams BJ. et al. Errors in allergen immunotherapy administration: a systems assessment. Ann Allergy Asthma Immunol 2013; 110: 205-206 DOI: 10.1016/j.anai.2012.12.005.
- 4 Melamed J, Mehra A, Ahuja-Malik A. A 5-year study of systemic reactions using both shared and patient-specific vaccines. Allergy Rhinol (Providence) 2013; 4: 88-93 DOI: 10.2500/ar.2013.4.0057.
- 5 James C, Bernstein DI. Allergen immunotherapy: an updated review of safety. Curr Opin Allergy Clin Immunol 2017; 17: 55-59 DOI: 10.1097/ACI.0000000000000335.
- 6 Nettis E, Giordano D, Ferrannini A. et al. Systemic reactions to allergen immunotherapy: a review of the literature. Immunopharmacol Immunotoxicol 2003; 25: 1-11 DOI: 10.1081/iph-120018279.
- 7 Kannan JA, Epstein TG. Immunotherapy safety: what have we learned from surveillance surveys?. Curr Allergy Asthma Rep 2013; 13: 381-388 DOI: 10.1007/s11882-013-0353-0.
- 8 Asero R. Pollen specific immunotherapy is not a risk factor for de novo sensitization to cross-reacting allergens in monosensitized subjects. J Investig Allergol Clin Immunol 2006; 16: 253-257
- 9 Gellrich D, Eder K, Hogerle C. et al. De novo sensitization during subcutaneous allergen specific immunotherapy – an analysis of 51 cases of SCIT and 33 symptomatically treated controls. Sci Rep 2020; 10: 6048 DOI: 10.1038/s41598-020-63087-4.
- 10 Spoerl D, Bircher AJ, Scherer K. Safety profile of hymenoptera venom immunotherapy (VIT) in monosensitized patients: lack of new sensitization to nontreated insect venom. J Investig Allergol Clin Immunol 2011; 21: 22-27