D1.197 - Safety and efficacy of a modified one-day ultra-rush protocol for the induction of Hymenoptera venom immunotherapy in patients with anaphylaxis in Switzerland

Venom immunotherapy (VIT) is the only causal treatment for Hymenoptera venom allergy and effectively prevents systemic allergic reactions after re-stings. Conventional up-dosing protocols require several days to weeks to reach the maintenance dose, which may delay protection and limit feasibility in certain clinical settings. Ultra-rush protocols offer rapid induction, but are associated with an increased risk of adverse reactions. To optimize safety while maintaining rapid efficacy, modified ultra-rush approaches have been developed.

We describe the structure, dosing schedule, and clinical implementation of a modified ultra-rush VIT protocol used at our Division of Allergy in Basel, Switzerland. The protocol achieves the target maintenance dose within a short time frame while incorporating adjusted dose increments and extended observation intervals. Safety measures, patient selection criteria, and monitoring procedures are outlined. Data on tolerability and adverse events during the up-dosing phase are summarized.

The modified ultra-rush protocol allows successful initiation of VIT within a single day or a short inpatient stay. Clinical experience indicates good tolerability, with predominantly mild and manageable systemic reactions and a low rate of therapy discontinuation. No severe or life-threatening adverse events were observed under strict monitoring conditions.

Our modified ultra-rush protocol represents a practical and safe alternative to conventional and classical ultra-rush VIT schedules. It enables rapid protection against Hymenoptera venom while maintaining a favorable safety profile. This approach may be particularly useful for patients with high sting risk or limited availability for prolonged up-dosing regimens.