In the case of bee venom immunotherapy, the vaccine should preferably contain the venom rather than the whole-body extract. They need to be shaken but not warmed before use. Allergen mixtures of unrelated allergens are not efficacious as they degrade easily and therefore should not be used. Adverse reactions to immunotherapy Most adverse reactions to immunotherapy are attributed to errors in dosage and timing. Special care should therefore be taken to ensure that the patient receives the correct dose at the correct time.
Adverse reactions are most likely to occur during the initial induction phase of immunotherapy.
Non-specific reactions such as excessive tiredness and headache are quite often reported but of no clinical significance. However, dizziness, itching and repeated clearing of the throat often precede a systemic reaction. A mild systemic reaction is indicated by intense itching, erythema, rhinitis, localized angioedema and is treated by antihistamines and reducing the next dose. The adrenaline injection may need to be repeated intravenously after 5 minutes if no improvement occurs. Oxygen and intravenous fluids may need to be administered with intravenous hydrocortisone 200mg and antihistamines in the case of generalised anaphylaxis.