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 for an in-the-field sting challenge — and find what would happen if I were actually stung by a honeybee — but now that I'm on Medicaid immunotherapy injections are just $2 for me, as are generic epinephrine auto-injectors! They do not come with a trainer, which are free by request. 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 full 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).

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. I'll be writing a post on my experience at Kaiser-Permanente when I'm close to reaching maintenance again, and if possible will include information on "How much does Venom Immunotherapy cost?".

*There is some controversy as to the usefulness of measuring IgG antibodies. 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

3 comments:

Julie D said...

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

Lauren said...

It's always good news to have allergy and life saving medication covered by insurance! I feel like the cost of an epi-pen should be 0 for someone with a life threatening allergy, even more so if they've already had an anaphylaxis reaction. Our healthcare system seems so broken and uncaring sometimes :(

Thank you for sharing your journey and therapy results, it's always fascinating to read the different ways to treat these issues and the results that people find.

HB said...

@Lauren Broken indeed. Who'da thought that health care could be so complicated? I have the same feelings about life-saving medication as you, although obviously I'm biased. It just isn't right that the drug manufacturers' prices escalate with how much a patient needs it.

I wish more people would blog about their therapy. It's hard to gauge what's normal. When I talk to the nurses, venom allergy patients are only a small percentage of the patients they see, so even their experience is limited. I'd love to know how others are doing.

P.S.: I checked out your website, and Michael Bush's "The Practical Beekeeper" and Kim Flottum's "The Backyard Beekeeper" are two of my favorite resources, too!

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