Initiating Honey Bee Venom Immunotherapy at the 100-µg Maintenance Dose versus Ultrarush Up-dosing: A Randomised Pilot Safety Study

Honey bee venom immunotherapy (VIT) is an incredibly effective treatment with efficacy reported to be around 95% at preventing severe allergic reactions. This translates not only to a mortality benefit in those with severe allergy, but also obviating the downstream quality of life morbidity of living with the potential for such a reaction and restrictions to participation thereof. Despite the clear benefits, conventional initiation/build-up strategies can be time-consuming. Ultrarush protocols deliver multiple escalating doses within a single day to reach higher doses quickly, while a “100-µg maintenance-dose initiation” strategy may simplify scheduling and patient participation by starting directly at the target dose. This pilot randomised study compares the safety of these two induction strategies in adults with confirmed honey bee venom allergy, focusing on systemic reactions graded by the “Brown” method and early immunologic changes (e.g. sIgE/sIgG4).