By Dr. Paul Ehrlich
For some time, my colleagues and I have been worried about the fact that one of the two major suppliers of insect venom for allergy shots was leaving the market. Now we are assured by both the AAAAI and ACAAI that the remaining supplier will be able to rise to the challenge. Their joint release that arrived in my mailbox reads:
Venom Extracts Will Not Be Interrupted/Reduced
On March 1 the ACAAI and the AAAAI sent a joint announcement on ALK’s departure from the North American venom extract market. This created initial concern that the previous short-term shortage would become long-term, affecting the care of thousands of venom allergic patients.
Fortunately, through the cooperation of Hollister-Stier with ALK and the FDA, the supply of venom extracts will not be interrupted or reduced. Hollister-Stier has provided not only reassurance, but ample evidence of their efforts to increase and improve their production of venom extracts—and to minimize the chance of future shortages. They claim to have sufficient supply on hand and in production to meet the total US demand.
As a result, allergists should not hesitate to prescribe and maintain full dose venom immunotherapy at normal intervals and to resume treatment if treatment had been interrupted. Rather than a permanent shortage we have been assured of an abundant supply.
This had been a source of concern in my practice where we have around 50 patients who need this therapy. Insect stings are estimated to be the third major cause of anaphylaxis behind medication and food, but they are second in fatalities at a level about twice that of food. Undoubtedly both would be higher if wasps and bees were not seasonal.
When I was training many years ago, extracts for insect (hymenoptera) shots were made by using the whole insect. Now the venom itself is extracted.
Most of the seminal work on insect allergies was done by my friend Dr. Robert Reisman, who wrote an original piece for this website a couple of years before he died. He spent years giving shots, hoping to find that they would result in tolerance, which is the case with other environmental and seasonal allergens such as pollen and dustmites. But he never hit that threshold, which is why the threat of venom shortages was so frightening for patients and allergists. Miss a shot or two and the patient is as vulnerable as ever. So let’s hope that Hollister-Stier can pick up the slack. And let’s hope that they don’t use their monopoly to gouge patients on cost.
(For an account of what insect anaphylaxis was like before immunotherapy and epinephrine autoinjectors, click here.)