【正文】 10(4):31822. 9. Golden DB. Epidemiology of allergy to insect venoms and stings.。s textbook of dermatology. 7 ed. Oxford: Blackwell Science。 112(3):4958. 6. Incorvaia C, Pucci S, Pastorello E. Clinical aspects of Hymenoptera venom allergy. . Allergy. 1999。 150:282330. 4. Muller U. New developments in the diagnosis and treatment of hymenoptera venom allergy. Int Arch Allergy Immunol. 2001。 351:197884. 2. King T, Lu G, Gonzalez M, Qian N, Soldatova L. Yellow jacket venom allergens, hyaluronidase and phospholipase: sequence similarity and antigenic crossreactivity with their hornet and wasp homologs and possible implications for clinical allergy. J Allergy Clin Immunol. 1996。mercial in confidence39。 for VIT in individuals with a history of anaphylaxis to bee and wasp venom. This section of the report will also consider budget impact and will take account of available information on current and anticipated patient numbers and service configuration for the treatment of this condition in the NHS. Systematic review of published economic literature The literature review of economic evidence will identify any relevant published costminimisation, costeffectiveness, costutility and/or costbenefit analyses. Economic evaluations/models included in the manufacturer submission(s) will be included in the review and critiqued as appropriate. Search strategy The search strategies detailed in section 5 will be adapted accordingly to identify studies examining the cost effectiveness of using Pharmalgen174。 for the treatment of bee and wasp venom allergy Page 11 of 21 Table 1: Inclusion criteria Intervention(s) Pharmalgen174。 in UK clinical practice. If suitable data are available, an economic model will be developed and populated to evaluate if the use of Pharmalgen174。 in providing immunotherapy to individuals with a history of type 1 IgEmediated systemic allergic reaction to bee and wasp venom. The review will consider the effectiveness of Pharmalgen174。 moderate or severe general reactions such as more severe asthma, angioedema or an anaphylactic reaction with hypotension and respiratory embarrassment。 local swelling (which may be immediate or delayed up to 48 hours)。 treatment with βblockers。 Bee or Wasp Venom is performed by subcutaneous injections. The treatment is carried out in two phases: the initial phase and the maintenance phase. In the build up phase, the dose is increased stepwise until the maintenance dose (the maximum tolerable dose before an allergic reaction) is achieved. ALK Abello remends the following dosage proposals: conventional, modified rush (clustered) and rush updosing. In conventional updosing, the patient receives one injection every 37 days. In modified rush (clustered) updosing, the patient receives 24 injections once a week. If necessary this interval may be extended up to two weeks. The 24 injections are given with an interval of 30 minutes. In rush updosing, while being hospitalised the patient receives injections with a 2hour interval. A maximum of four injections per day may be given in the initial phase. The build up phase ends when the individual maintenance dose has been attained and the interval between the injections is increased to 2, 3 and 4 weeks. This is called the maintenance phase, and the maintenance dose is then given every 4 weeks for at least 3 years. Contraindications to VIT treatment are immunological diseases (e. g. immune plex diseases and immune deficiencies)。 Wasp Venom and freeze dried Apis mellifera venom in Pharmalgen174。 Bee Venom) and wasp venom (Pharmalgen174。 (HollisterStier Laboratories LLC, unlicensed in the UK). Venom immunotherapy is remended to prevent future systemic reactions. It is remended that VIT is considered ‘when positive test results for specific IgE antibodies correlate with suspected triggers and patient exposure’.27 Venom immunotherapy consists of subcutaneous injections of increasing amounts of venom, and treatment is divided into two periods: the build up phase and maintenance phase. Venom immunotherapy is now the standard therapy for Hymenoptera sting allergy,28 and is a model for allergenspecific therapy,2930 with success rates (patients who will remain anaphylaxis free) being reported as more than 98% in some , 31 There are now 44 centres across the UK which provide VIT to people for bee and wasp sting allergy. Venom immunotherapy is normally discontinued after 3 to 5 years, but modifications may be necessary when treating people with intense allergen exposure (such as beekeepers) or those with individual risk factors for severe reactions. There is no method of assessing which patients will be at risk of further anaphylactic reactions following administration of VIT and those who will remain anaphylaxis free in the long term following Local or systemic adverse reactions may occur as a result of VIT. They normally develop within 30 minutes of the injection. Each patient is monitored closely following each injection to check for adverse reactions. Progression to an increased dose only occurs if the previous dose is fully tolerated. The technology Pharmalgen174。 (HAL Allergy, Leiden, Netherlands, unlicensed in the UK), Alyostal174。 and Alutard SQ174。). These are intended for immediate selfadministration by individuals with a history of hypersensitivity to Hymenoptera stings and other allergens. Preventive measures following successful treatment of a systemic allergic reaction to Hymenoptera venom consists of either allergen avoidance or specific allergen immunotherapy, known as VIT. Venom immunotherapy is considered to be a safe and effective Currently, VIT can be used with several regimes, including Pharmalgen174。, Anapen174。 is of clinical value when providing VIT to individuals with a history of severe reaction to bee and wasp venom and whether doing so would be considered cost effective pared with alternative treatment options available in the NHS. Background Bees and wasps form