D3.427 - Current practices in diagnosis and treatment of Hymenoptera venom allergy (HVA) in Poland

The audit is carried out at regular intervals to assess current practices in Polish specialist allergy centres. It aims to assess the availability of diagnostic and treatment procedures for patients with HVA and their compliance with current guidelines. 

Survey was conducted by CAWI method among 62 Polish allergy centres, with a response rate of 94%. 

Among respondents, 74% provide diagnosis and 66% provide treatment. Most centres (40%) deal exclusively with adults, 30% with children and 30% with both age groups. Both diagnostics (88%) and VIT (97%) remain hospital-based procedures. The total number of patients currently treated is 3124; adults outnumber children by a ratio of about 6:1. For diagnosis, 50% use skin prick tests (SPT), all with a highest concentration of 100mcg/ml, 76% perform intradermal tests (IDT), mostly (91%) step-wise, with a highest concentration of 1mcg/ml (63%), 93% perform sIgE, while only 43% assess total IgE. Almost 86% use sIgE as a first-line assessment. Regardless of the severity of the systemic reaction, CRD (88%), BAT (14%) and bsT (79%) are additionally evaluated. When standard diagnostic tests are negative, almost 81% of centres perform CRD and 19% perform BAT. Almost ¾ start VIT using the ultra-rush (UR) protocol. Almost 2/3 continue pharmacotherapy for comorbidities. If systemic side effects occur during the incremental phase, 34% change to a cluster protocol or switch to depot extract (31%). Almost half use antihistamines in all patients. Almost all centers use a maintenance dose (MD) of 100 mcg/ml, the others 100,000 SQ-U/ml. In 57% of cases, the first MD is 100 mcg, divided in half and continued usually 4 weeks apart. Almost all (90%) continue VIT for 5 years. Before the end of treatment, some centers perform skin tests (13% SPT, 16% IDT), 34% assess sIgE. 13% perform a sting challenge test during or before completion of VIT. After completion, 47% of centers support patients without mastocytosis with AAI. For patients with mastocytosis, 81% of centers support them with adrenaline during diagnosis (81%), during the MD phase (95%) and after completion of VIT (92%) and use longer than standard treatment (95%). Only 46% of centers assess quality of life (QoL) in patients with HVA. 

Standard diagnostics practices are highly consistent with recommendations. Diagnosis is dominated by sIgE assessment for both extract and components. The UR protocol is widely used. QoL assessment remains a rare practice.