April 09, 2017

Q: I have been getting monthly allergy shots but have missed getting them for the last 4 months. Can I pick up where I left off?

Actually, I missed getting them for 9 months. I never went to Marty for in-the-field therapy because last I checked I was still highly sensitive to honeybee venom, and I didn't think it was fair to put him in a situation. He didn't care but I'm not that cavalier.

I can't believe it took me 9 months to work through the transition from employer-provided to marketplace to state-sponsored health insurance. During that time, I switched doctors. Colorado Allergy & Asthma Centers rarely had answers to my questions, and it was time to work with someone who did. My new allergist definitely does things differently. He actually listens and thinks. He even asked, "What's so fascinating about bees?"

A post shared by My brain runs on Bees. (@backyardbee) on

When it comes to anaphylaxis, a conservative approach is de rigeur. He ordered new labs to determine my level of IgG (protective) as well as IgE (allergic) antibodies. Kaiser Permanente kindly threw in a cholesterol check gratis, since they had me in the chair. While CAAC's findings only showed my level of sensitivity, the new test shows I also have some degree of protection at least to honey bee. Yes! I'm tempted again to go to Marty but now that I'm on Medicaid, immunotherapy injections are just $2 for me, as are generic epinephrine auto-injectors! Surprisingly they did not come with a trainer. They are, however, free by request so if your insurance only covers generic, be sure to get one as they work rather differently from Epi-Pens.

Anyway, the question was, "Can I pick up where I left off?" The answer is, "Yes and no." Because of the amount of time lapsed I must go through a 15-shot build phase but then I can resume maintenance shots where I left off, to complete the five years total (combined time on shots at CAAC and Kaiser).

Under normal circumstances, I'd get through the build phase two injections a week. But there's a national venom shortage! To make sure they don't run into a supply challenge, Kaiser's recommending I come once a week. If the build phase gets disrupted, I'll have to start over again, again. Ugh, I just want to get it over with! Or head to Marty's house where I know there's plenty of venom. Surprisingly, when I told the allergist about my mentor's willingness to administer in-the-field therapy, he said, "Do it in the parking lot of the ER." Maybe he's read this paper.
"A sting challenge with a single, live insect can be used in treated patients to identify those who are not protected.[112] This should be performed in an emergency care setting approximately 6–18 months after the maintenance dose has been reached…" Source: "Hymenoptera Venom Immunotherapy," Beatrice M Bilò; Floriano Bonifazi, Immunotherapy. 2011;3(2):229-246.
So that's the VIT update, almost 4 years post-anaphylaxis to the day.

There is some controversy as to the usefulness of measuring IgG anti-bee venom. Some studies have found it to be useful and others have not.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.1983.tb02592.x/abstract
http://www.aaaai.org/ask-the-expert/venom-immunotherapy-beekeeper
http://www.aaaai.org/ask-the-expert/igg-honey-bee

1 comments:

Julie D said...

That's great news that you can get your VIT covered by insurance! Whoo hoo!

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