(WebMD) Taking allergy drops instead of enduring painful shots may
someday become an option for people who are allergic to honeybee
stings.

In a preliminary study, Italian researchers found that putting
honeybee venom under the tongue was safe and significantly reduced
reactions in people allergic to bee stings .

Immunotherapy using the ubiquitous allergy shot is the standard
treatment for allergies to everything from insect stings to dust
mites. Tiny amounts of the allergens are injected into the patient
until tolerance develops.

The new study involved a different form of immunotherapy, called
sublingual immunotherapy. It involves putting extracts of allergens
under the tongue. Like the shots, sublingual immunotherapy reduces
allergic sensitivity in many patients over time.

Although a popular treatment for asthma , rubber latex, and other
allergies in many European countries, sublingual therapy has not
been approved for use in the U.S.

And it's never been used to treat sting allergies, even in Europe,
says researcher Giovanni Passalacqua, MD, of the Allergy and
Respiratory Diseases Clinic at the University of Genoa.


Honeybee Venom Drops vs. Placebo

The new study, presented here at the annual meeting of the American
Academy of Allergy, Asthma and Immunotherapy (AAAAI), is the first
attempt to determine if sublingual immunotherapy is effective
against honeybee sting allergies, Passalacqua says.

The study involved 30 people with a history of local allergic
reactions to honeybee stings. A local reaction is a large raised
patch of pricked skin right in the area of the sting. These raised
bumps are often called wheals.

The participants were randomly assigned to receive either sublingual
immunotherapy in the form of honeybee venom drops placed under the
tongue, or placebo drops.

Patients in the immunotherapy group got escalating doses of honeybee
venom for six weeks, followed by a maintenance dose, given three
times a week for six months.

"You hold the drop under the tongue for about one or two minutes,
then swallow," Passalacqua says.


The Bee Sting Challenge

Then came the bee sting challenge. "We put insects in a jar and then
put the jar on the patient's forearm" and looked to see what
happened, he says.

It worked. The median diameter of the sting wheals in patients given
sublingual immunotherapy dropped from about 8 to 3 inches. Looked at
another way, wheal diameter was reduced by more than 50% in more
than half of them.

"This was a very apparent and very significant reduction in the size
of the reaction to the sting," Passalacqua says.

In contrast, there was no change in wheal diameter in the placebo
group, and one person broke out in hives .

The findings show that sublingual immunotherapy against honeybee
stings works, Passalacqua says.


Venom Shots Are Effective

The next step: Testing sublingual immunotherapy in patients who have
more severe allergic reactions that spread far from the sting or
that affect the entire body. Doctors call these systemic reactions;
while uncommon, they can be life-threatening.

Clifford Bassett, MD, vice chair of AAAAI's public education
committee and an allergist at Long Island College Hospital in
Brooklyn, N.Y., says that if sublingual immunotherapy proves safe
and effective in larger numbers of people, "it will offer an
alternative treatment for our patients. It's always good to have
multiple choices."

In the meantime, he tells WebMD, venom shots are more than 95%
effective in reducing the risk of systemic reactions in people with
honeybee sting allergies.

While not always possible, avoiding the bees in the first place is
the first line of defense, Bassett adds. A few tips: avoid cologne
and trash collection areas where the insects congregate.


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