β-blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy.

Sturm, Gunter JohannesHerzog, Sereina AnnikAberer, WernerAlfaya Arias, TeresaAntolin-Amerigo, DarioBonadonna, PatriziaBoni, ElisaBożek, AndrzejChełmińska, MartaErnst, BarbaraFrelih, NinaGawlik, RadoslawGelincik, AsliHawranek, ThomasHoetzenecker, WolframJimenez Blanco, AranzazuKita, KarolinaKendirlinan, ReşatKošnik, MitjaLaipold, KarinLang, RolandMarchi, FrancescoMauro, MarinaNittner-Marszalska, MaritaPoziomkowska-Gęsicka, IwonaPravettoni, ValerioPreziosi, DonatellaQuercia, OlivieroReider, NorbertRosiek-Biegus, MartaRuiz-Leon, BertaSchrautzer, ChristophSerrano, PilarSin, AytülSin, Betül AyşeStoevesandt, JohannaTrautmann, AxelVachova, MartinaArzt-Gradwohl, Lisa2023-02-092023-02-092021-01-20Sturm GJ, Herzog SA, Aberer W, Alfaya Arias T, Antolín-Amérigo D, Bonadonna P, et al. β-blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy. Allergy. 2021 Jul;76(7):2166-2176http://hdl.handle.net/10668/17198There 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). 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. 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. 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.enAttribution-NonCommercial 4.0 Internationalhttp://creativecommons.org/licenses/by-nc/4.0/ACE inhibitorAdverse eventBeta-blockerSystemic insect sting reactionVenom immunotherapyAnaphylaxisAngiotensin-converting enzyme inhibitorsBee venomsDesensitization, immunologicHumansInsect bites and stingsProspective studiesRisk factorsβ-blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy.research article33605465open accessAnafilaxiaDesensibilización inmunológicaEstudios prospectivosFactores de riesgoInhibidores de la enzima convertidora de angiotensinaMordeduras y picaduras de insectosVenenos de abeja10.1111/all.147851398-9995PMC8359427https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/all.14785https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359427/pdf