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Saretta F, Giovannini M, Pessina B, Barni S, Liccioli G, Sarti L, Tomei L, Fazi C, Pegoraro F, Valleriani C, Ricci S, Azzari C, Novembre E, Mori F. Venom immunotherapy protocols in the pediatric population: how to choose? Front Pediatr 2023; 11:1192081. [PMID: 37744438 PMCID: PMC10512975 DOI: 10.3389/fped.2023.1192081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/05/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Mattia Giovannini
- Department of Health Sciences, University of Florence, Florence, Italy
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Benedetta Pessina
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Simona Barni
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Giulia Liccioli
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Lucrezia Sarti
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Leonardo Tomei
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Camilla Fazi
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Silvia Ricci
- Department of Health Sciences, University of Florence, Florence, Italy
- Immunology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Chiara Azzari
- Department of Health Sciences, University of Florence, Florence, Italy
- Immunology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Elio Novembre
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
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Johnston N, Belcher J, Preece K, Bhatia R. Review of venom immunotherapy at a regional tertiary paediatric centre. J Paediatr Child Health 2022; 58:1228-1232. [PMID: 35416342 DOI: 10.1111/jpc.15964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/18/2022] [Accepted: 03/09/2022] [Indexed: 11/28/2022]
Abstract
AIM Bee stings can result in allergic reactions, including anaphylaxis. Venom immunotherapy (VIT) is a definitive cure for bee venom allergy, but controversy surrounds whether accelerated protocols are safe in children. Our primary aim was to assess the safety profile of ultra-rush bee VIT compared with conventional bee VIT at a regional paediatric tertiary centre. We also sought to evaluate the impact of both approaches on time and resource use. METHODS Data were collected retrospectively from 14 patients with bee venom allergy who were treated with ultra-rush or conventional bee VIT between 2013 and 2021 at John Hunter Children's Hospital. We compared VIT-associated adverse reactions and use of resources in both these groups. RESULTS Overall, six patients received ultra-rush bee VIT and eight patients received conventional VIT. The ultra-rush group had a lower rate of systemic reaction (16%) compared with the conventional group (25%). One patient from the conventional group required adrenaline. Ultra-rush patients require fewer injections over a shorter time and fewer hospital visits to complete the protocol. Travel distance for families was significantly reduced. CONCLUSION At our regional paediatric tertiary centre, ultra-rush bee VIT was a safe treatment option for children with bee venom allergy. It has many advantages over a conventional approach, especially for patients living in regional or remote areas.
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Affiliation(s)
- Niall Johnston
- Department of Paediatric Allergy and Immunology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,Faculty of Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jan Belcher
- Department of Paediatric Allergy and Immunology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Kahn Preece
- Department of Paediatric Allergy and Immunology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,Faculty of Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Rani Bhatia
- Department of Paediatric Allergy and Immunology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,Faculty of Medicine, University of Newcastle, Newcastle, New South Wales, Australia
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Venom allergy treatment practices in Poland in comparison to guidelines: next edition of the national audit. Postepy Dermatol Alergol 2019; 36:346-353. [PMID: 31333352 PMCID: PMC6640023 DOI: 10.5114/ada.2019.85642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/01/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Venom immunotherapy treatment (VIT) is the only causal treatment of hymenoptera venom anaphylaxis, which aims to provide long-lasting immunoprotection against severe reactions to subsequent stings. Aim To reassess the compliance of VIT procedures in the Polish allergy centres with the European guidelines. Material and methods A structured questionnaire survey conducted in all 33 VIT-centres. The response rate was 94%. Results The ultrarush initial protocol was the most common protocol (71%, n = 22), usually lasting for 3.5 h (50%, n = 7). The most frequent (36%, n = 11) time interval from the initial to the first maintenance dose (MD) was 14 days, ranging from 7 to 35 days. All centres used an MD of 100 μg. The most frequent time interval between subsequent MDs was 4 weeks (58%, n = 18). Five years’ of VIT was declared by 71% (n = 22). Before the termination of treatment, more than half of the centres (58%, n = 18) performed sIgE and almost half (42%, n = 13) performed skin tests. To confirm VIT efficacy, few centres (26%, n = 8) conducted the sting challenge. About half of centres provided the patients with an adrenalin auto-injector both at the time of initial diagnostics and at the end of treatment. More than half (55%, n = 17) used antihistamines in all patients. Almost half (45%, n = 14) declared to stop treatment with β-blockers and almost one fourth (23%, n = 7) discontinued angiotensin-converting-enzyme inhibitors. Conclusions In the most important procedures, there is a very high compliance with the guidelines. In the areas where the guidelines are not precise, we observed a large spread of results.
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Diwakar L, Ewan P, Huber PAJ, Clark A, Nasser S, Krishna MT. The impact of national guidelines on venom immunotherapy practice in the United Kingdom. Clin Exp Allergy 2018; 46:749-53. [PMID: 26989871 PMCID: PMC4869676 DOI: 10.1111/cea.12728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- L Diwakar
- University of Birmingham and University Hospitals Birmingham, Birmingham, UK
| | - P Ewan
- Allergy clinic, Addenbrookes Hospital, Cambridge, UK
| | | | - A Clark
- Allergy clinic, Addenbrookes Hospital, Cambridge, UK
| | - S Nasser
- Allergy clinic, Addenbrookes Hospital, Cambridge, UK
| | - M T Krishna
- Heart of England NHS Foundation Trust and Aston University, Birmingham, UK
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Incorvaia C, Mauro M, Gritti BL, Makri E, Ridolo E. Venom immunotherapy in patients with allergic reactions to insect stings. Expert Rev Clin Immunol 2017; 14:53-59. [PMID: 29202591 DOI: 10.1080/1744666x.2018.1413350] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Allergy to Hymenoptera (Apis mellifera, Vespula species, Polistes species, Vespa crabro) venom can be safely and effectively treated by venom immunotherapy (VIT), which in the 40 years since its introduction has been able to prevent reactions to stings, and to treatment as well, though systemic reactions, occasionally severe, are possible. Areas covered: We reviewed the recent literature on VIT by searching in PubMed for the terms 'venom immunotherapy' and 'Hymenoptera venom immunotherapy' to highlight the current status of VIT and the likely development in the coming years. Expert commentary: VIT, provided the correct choice of the venom and adequate venom preparations and maintenance doses are used, is a treatment of great value in preventing systemic reactions to Hymenoptera stings. A 5-year duration ensures a prolonged tolerance to stings following VIT discontinuation, unless patients suffer from mastocytosis. In fact, due to reports of fatal reactions after stopping VIT, patients with mastocytosis, or with very severe reactions to stings, need an indefinite duration of treatment.
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Affiliation(s)
| | - Marina Mauro
- b Department of Clinical & Experimental Medicine , University of Parma , Parma , Italy
| | - Bruna L Gritti
- a Cardiac/Pulmonary Rehabilitation , ASST Pini/CTO , Milan , Italy
| | - Eleni Makri
- a Cardiac/Pulmonary Rehabilitation , ASST Pini/CTO , Milan , Italy
| | - Erminia Ridolo
- c Allergy Unit , Sant'Anna Hospital, ASST Lariana , Como , Italy
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Jarrett R, Salio M, Lloyd-Lavery A, Subramaniam S, Bourgeois E, Archer C, Cheung KL, Hardman C, Chandler D, Salimi M, Gutowska-Owsiak D, de la Serna JB, Fallon PG, Jolin H, Mckenzie A, Dziembowski A, Podobas EI, Bal W, Johnson D, Moody DB, Cerundolo V, Ogg G. Filaggrin inhibits generation of CD1a neolipid antigens by house dust mite-derived phospholipase. Sci Transl Med 2016; 8:325ra18. [PMID: 26865566 PMCID: PMC4872823 DOI: 10.1126/scitranslmed.aad6833] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Atopic dermatitis is a common pruritic skin disease in which barrier dysfunction and cutaneous inflammation contribute to pathogenesis. Mechanisms underlying the associated inflammation are not fully understood, and although Langerhans cells expressing the nonclassical major histocompatibility complex (MHC) family member CD1a are known to be enriched within lesions, their role in clinical disease pathogenesis has not been studied. We observed that house dust mite (HDM) allergen generates neolipid antigens presented by CD1a to T cells in the blood and skin lesions of affected individuals. HDM-responsive CD1a-reactive T cells increased in frequency after birth in individuals with atopic dermatitis and showed rapid effector function, consistent with antigen-driven maturation. In HDM-challenged human skin, we observed phospholipase A2 (PLA2) activity in vivo. CD1a-reactive T cell activation was dependent on HDM-derived PLA2, and such cells infiltrated the skin after allergen challenge. Moreover, we observed that the skin barrier protein filaggrin, insufficiency of which is associated with atopic skin disease, inhibited PLA2 activity and decreased CD1a-reactive PLA2-generated neolipid-specific T cell activity from skin and blood. The most widely used classification schemes of hypersensitivity suggest that nonpeptide stimulants of T cells act as haptens that modify peptides or proteins; however, our results show that HDM proteins may also generate neolipid antigens that directly activate T cells. These data define PLA2 inhibition as a function of filaggrin, supporting PLA2 inhibition as a therapeutic approach.
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Affiliation(s)
- Rachael Jarrett
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Radcliffe Department of Medicine, University of Oxford, UK
| | - Mariolina Salio
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Radcliffe Department of Medicine, University of Oxford, UK
| | - Antonia Lloyd-Lavery
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Radcliffe Department of Medicine, University of Oxford, UK
| | - Sumithra Subramaniam
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Radcliffe Department of Medicine, University of Oxford, UK
| | - Elvire Bourgeois
- Division of Rheumatology, Immunology and Allergy, Department of Medicine Brigham and Women’s Hospital, Harvard Medical School, 1 Jimmy Fund Way, Boston, Massachusetts, 02114, USA
| | - Charles Archer
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Radcliffe Department of Medicine, University of Oxford, UK
| | - Ka Lun Cheung
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Radcliffe Department of Medicine, University of Oxford, UK
| | - Clare Hardman
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Radcliffe Department of Medicine, University of Oxford, UK
| | - David Chandler
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Radcliffe Department of Medicine, University of Oxford, UK
| | - Maryam Salimi
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Radcliffe Department of Medicine, University of Oxford, UK
| | - Danuta Gutowska-Owsiak
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Radcliffe Department of Medicine, University of Oxford, UK
| | - Jorge Bernardino de la Serna
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Radcliffe Department of Medicine, University of Oxford, UK
| | - Padraic G. Fallon
- Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
- Institute of Molecular Medicine, St James’s Hospital, Dublin, Ireland
- National Children’s Research Centre, Our Lady’s Childrens Hospital, Dublin, Ireland
| | - Helen Jolin
- MRC Laboratory of Molecular Biology, Cambridge, UK
| | | | - Andrzej Dziembowski
- Institute of Biochemistry and Biophysics Polish Academy of Sciences, Warsaw, Poland
| | - Ewa Izabela Podobas
- Institute of Biochemistry and Biophysics Polish Academy of Sciences, Warsaw, Poland
| | - Wojciech Bal
- Institute of Biochemistry and Biophysics Polish Academy of Sciences, Warsaw, Poland
| | - David Johnson
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, UK
| | - D Branch Moody
- Division of Rheumatology, Immunology and Allergy, Department of Medicine Brigham and Women’s Hospital, Harvard Medical School, 1 Jimmy Fund Way, Boston, Massachusetts, 02114, USA
| | - Vincenzo Cerundolo
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Radcliffe Department of Medicine, University of Oxford, UK
| | - Graham Ogg
- MRC Human Immunology Unit, NIHR Biomedical Research Centre, Radcliffe Department of Medicine, University of Oxford, UK
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Cichocka-Jarosz E, Diwakar L, Brzyski P, Tobiasz-Adamczyk B, Lis G, Pietrzyk JJ. Congruence of the current practices in Hymenoptera venom allergic patients in Poland with EAACI guidelines. Arch Med Sci 2011; 7:832-9. [PMID: 22291828 PMCID: PMC3258816 DOI: 10.5114/aoms.2011.25558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 10/05/2010] [Accepted: 10/26/2010] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Venom immunotherapy (VIT) practice is the definitive treatment for patients with potentially fatal allergic reactions to Hymenoptera stings. The aim is assesing compliance of VIT practice in Poland with the current European Academy of Allergy and Clinical Immunology (EAACI) guidance. MATERIAL AND METHODS A multicentre study was carried out using a structured questionnaire which was sent by post to all VIT practitioners in Poland. Some questionnaire items were altered, in comparison to original version by adding additional answer options or alowing multiple answer option. The response rate was 100%. The obtained results were compared with the published EAACI guidelines. RESULTS Twenty-six Polish centres took part in the survey. SSIgE and skin prick tests (SPT) are together used as the first line of investigation, whereas confirmatory intradermal tests (IDT) are applied in half of centres. Only a few centres measure baseline serum tryptase levels. The ultra-rush protocol is preferred. Antihistamine pre-medication is routinely practiced. A target dose equal to 100 µg is used in most centres. A 6-week interval between booster doses is the most frequent. Five years is considered as an optimal VIT duration. Before the VIT completion, SSIgE is evaluated in fifty percent of centres, whereas sting challenge is considered by half of responders. CONCLUSIONS There are some differences between current practice in Poland and the EAACI recommendations, indicating areas requiring better compliance. Comparision between Poland and the United Kingdom revealed that health service organization and health care funding may play a major role in the provision of allergy services. This may affect the extent to which international guidance may be applied in individual countries. It is worth considering conducting the same survey in other European countries.
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Affiliation(s)
- Ewa Cichocka-Jarosz
- Department of Pediatrics, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow, Poland
- Corresponding author: Ewa Cichocka-Jarosz MD, PhD, Department of Pediatrics Polish-American Children's Hospital, Jagiellonian University Medical College, 265 Wielicka, 30-663 Krakow, Poland, Phone: 48 12 658 20 11, ext. 1655, Fax: 48 12 658 44 46. E-mail:
| | - Lavanya Diwakar
- Department of Allergy and Immunology, Heartlands Hospital, Birmingham, United Kingdom
| | - Piotr Brzyski
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Beata Tobiasz-Adamczyk
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Grzegorz Lis
- Department of Pediatrics, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek J. Pietrzyk
- Department of Pediatrics, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow, Poland
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Abstract
Subcutaneous venom immunotherapy is the only effective treatment for patients who experience severe hymenoptera sting-induced allergic reactions, and the treatment also improves health-related quality of life. This article examines advances in various areas of this treatment, which include the immunological mechanisms of early and long-term efficacy, indications and contraindications, selection of venom, treatment protocols, duration, risk factors for systemic reactions in untreated and treated patients as well as for relapse following cessation of treatment. Current and future strategies for improving safety and efficacy are also examined. However, although progress in the past few years has been fruitful, much remains to be accomplished.
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Affiliation(s)
- Beatrice M Bilò
- Department of Internal Medicine, Immunology, Allergy & Respiratory Diseases, University Hospital, Ospedali Riuniti di Ancona, Ancona, Italy.
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Krishna MT, Huissoon AP. Clinical immunology review series: an approach to desensitization. Clin Exp Immunol 2010; 163:131-46. [PMID: 21175592 DOI: 10.1111/j.1365-2249.2010.04296.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Allergen immunotherapy describes the treatment of allergic disease through administration of gradually increasing doses of allergen. This form of immune tolerance induction is now safer, more reliably efficacious and better understood than when it was first formally described in 1911. In this paper the authors aim to summarize the current state of the art in immunotherapy in the treatment of inhalant, venom and drug allergies, with specific reference to its practice in the United Kingdom. A practical approach has been taken, with reference to current evidence and guidelines, including illustrative protocols and vaccine schedules. A number of novel approaches and techniques are likely to change considerably the way in which we select and treat allergy patients in the coming decade, and these advances are previewed.
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Affiliation(s)
- M T Krishna
- Department of Allergy and Immunology, Birmingham Heartlands Hospital, UK.
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Importance of basophil activation testing in insect venom allergy. Allergy Asthma Clin Immunol 2009; 5:11. [PMID: 20016774 PMCID: PMC2794846 DOI: 10.1186/1710-1492-5-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 12/01/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Venom immunotherapy (VIT) is the only effective treatment for prevention of serious allergic reactions to bee and wasp stings in sensitized individuals. However, there are still many questions and controversies regarding immunotherapy, like selection of the appropriate allergen, safety and long term efficacy. METHODS Literature review was performed to address the role of basophil activation test (BAT) in diagnosis of venom allergy. RESULTS In patients with positive skin tests or specific IgE to both honeybee and wasp venom, IgE inhibition test can identify sensitizing allergen only in around 15% and basophil activation test increases the identification rate to around one third of double positive patients. BAT is also diagnostic in majority of patients with systemic reactions after insect stings and no detectable IgE. High basophil sensitivity to allergen is associated with a risk of side effects during VIT. Persistence of high basophil sensitivity also predicts a treatment failure of VIT. CONCLUSION BAT is a useful tool for better selection of allergen for immunotherapy, for identification of patients prone to side effects and patients who might be treatment failures. However, long term studies are needed to evaluate the accuracy of the test.
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Korosec P, Erzen R, Silar M, Bajrovic N, Kopac P, Kosnik M. Basophil responsiveness in patients with insect sting allergies and negative venom-specific immunoglobulin E and skin prick test results. Clin Exp Allergy 2009; 39:1730-7. [DOI: 10.1111/j.1365-2222.2009.03347.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Long AA, Camargo CA. Current practice of venom immunotherapy in the UK. Clin Exp Allergy 2008; 38:1576-8. [DOI: 10.1111/j.1365-2222.2008.03077.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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