Te clinicala cos-efctivenessoPhmage o th treatme of bee and wasp enom ale 1 ITE OF POJTTlinil nd tefectveness of harmalgen forthetatmeto bee and wsp veomllergy 2R A ivrpo Revie andImpleentio Goup (LRiG), Universit of vepol Correondne to:Rumona ickso, M Ditor, RG Unieityof Liverpoo oom.12 Whan Biding he Quadrngle Brownlw Hl Lio 3GB Tel: +44(0) 151 94 582 Fax:44 (0）151 794 85 mail： For detais o xpertie within the TAR team，se setin 7. 3 PLAIN NGLIS SMMRYAlegic reatios tobe andwapvenoma ocr i enom-sste patiets ediatly foloi a sti， and can ar ineeriy, wit initially mid syps smtimes progessin tocriica cdins ithinsods. The most er sstmi allegireations （genealisedrctins）re know anpyaxi, a reactincaaterie y abnormaly ow blod sue， fatiocapse, an in extreme ratns hes sympt ca ause deat. Ec year intheUK ther arbtewo ad nne deth fro anahylis cause bybee nd aspvenm. The imediate tratmen f svere allrg reactionsto e ndwsp eno ns of emegencetment with drugs odase h paients resnse othevom d suprt beathing， reud. T void frther rections， e ueofsenstsation t bee anp nom， trough a pocess know a vnoimmnotheray（VI）, has be invetigaed. Vnm immunotheay cnsistsof sbcutaneousnjections of incrigamouts fvenom ito ptits wit ity of anahylaxstbeeand waspvenm.harmalgenhaU marketingauthoriati for te iagnois ad ratment (usin I) of aller t e vno (using Parmalg ee e) and wpvom(uin Phalge Wasp Vnom)iceMrh 195,nd it s sedby more hn 40 centresacos the U.his rview aims oaess whher using Phrmagnin T isclinicll usefulhn trtn popewih a history o sereecion to bee and wasp tings.Te eview will opare preventiveeatment wth Phrmlgetoother retmn opton, icdin high dse athistaines， advic ntevoiace of be andwap ting and arenalieto-ijector precripton antranng.itableatre aailable,hervie wll l cnsider the ct effties of usg Pharlgen or VIan otersubgoupsnluding childreand peole at hih risk o future tingsor sere allrg ractions tofuture stins 4 ECISON PRBLM 4.1Crficato of resech qestio and so harmalgnis sed forthediagnsi and remnt ofmmunogobin E （gE)-eiated alergy tobe andwasp venom. Theaim of this reprts to assess wther theuse of Phagen is of clnical value when prodig VIT tindividuals with a hisry o seve rcion t be ad wasp vnm andwhetheroin so wold b csidered cos efetie comped t alrnatv reamenotins ailablin the NH . ckground Bes adwasps frm part f th order Hynopra(which als ncesans), and ithn this orde t seces tt cause th mosfrequent allergc reacons rethe Vepdae (s, ellow jackets and hrnets), and thinae （honeye).1Bee ad wap tings cnin arc proeins. n sps， theseaedominanlphospholaseA，2 hyalrndase2 and atge ,3 and besre phsphlp A2 nd yalrondas.4 ollowingan inial stin， a t1 ypesitiityratiomy ocur nme induls whih prodes th Ig antiby. hiseniie els to the llergen, an ay suseu expour totealegn my aseh alrge o bindo t I eculs， which reults in an alerc retion. Theleenstypicalyprodceintne, burnng ain olowed y rthema （redness） nd a mall rea of oedea (wellig) at the te h stg. Th symptos produe following ating n be cassifitono-lec eacin， sch a cl eacions,and llegi reations， suh extenie oaleans，napylti sysemicreactions and delae systmi reactions.-6 Systmic alegreactions ma ocu n vensensitiv patiet immediately folowing n, and can aryeeity，witiitally midsymtmomtespgresingto rticl condiionswithin sen. T mostseer systemic alergc reactio is kw asnaphax.Anaphylactc reacion ar of rapidonst (typcall u to 1 miutes ptstin) and n manifest different ays. tlytomseusuly cutnosfolowd y hyptnion,t lgh-eadens, fintng r colape. Som pop deeo rspratory yptos ue o an athm-like response orlyngeale. sevr rectons,hypotenon,culaoy disurbancs,and bathing dificult can progss t ftal ardi-resiraory arrest Anphylais occ