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Modified rush venom immunotherapy in dogs with Hymenoptera hypersensitivity

View more insights in Professional - Veterinary Medicine

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Mandy Burrows research shows that hymenoptera envenomation occurs frequently in people and dogs and can trigger anaphylaxis.

Image courtesy of interviewee. May 1, 2024

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This video video discusses venom veneration and venom immunotherapy (VIT), a treatment aimed at desensitizing individuals (both humans and animals) who are prone to severe allergic reactions, specifically anaphylaxis, from bee and wasp stings. The speaker, a veterinarian and dermatologist specialized in allergies, elaborates on a study conducted with dogs in Western Australia that utilized a protocol adapted from pediatric medicine, allowing for faster desensitization compared to traditional methods which require 16-19 weeks.

In this study, 20 dogs that had previously experienced life-threatening anaphylactic reactions were treated with controlled doses of venom over a condensed three-week period instead of the usual prolonged schedule. Results showed that the protocol was safe, with half of the dogs experiencing no side effects and the other half experiencing mild and manageable issues like injection site irritation, nausea, and diarrhea.

The speaker emphasizes the importance of informing pet owners about the possibility of VIT for their animals and suggests that further research could explore even more efficient immunotherapy protocols. Additionally, the resident who presented this research at an American conference received an award for her project, indicating the study's significance in improving veterinary care and understanding of anaphylactic reactions in pets.

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X-TIMESTAMP-MAP:LOCAL=00:00:00.000,MPEGTS=900000

00:00.000 --> 00:01.965
What I can tell you about venom, venom

00:02.065 --> 00:05.565
and venom immunotherapy is VIT is venom immunotherapy.

00:05.825 --> 00:08.445
So what that means, it's a way that we can treat

00:09.225 --> 00:12.645
and prevent, anaphylactic reactions

00:12.735 --> 00:15.005
after repeated allergic exposure.

00:15.185 --> 00:18.405
So what we're talking about here is people, humans

00:18.985 --> 00:23.125
who can develop really severe anaphylactic reactions

00:23.125 --> 00:24.125
after being stung.

00:24.345 --> 00:26.205
So by bees and by wasps.

00:26.545 --> 00:28.205
And what we know in humans is

00:28.205 --> 00:32.285
that you can very effectively desensitize somebody to a bee

00:32.345 --> 00:34.725
or a wasp sting that could be life-threatening.

00:35.185 --> 00:38.725
And we can do that in dogs and cats and horses.

00:39.345 --> 00:41.845
And so I'm a veterinarian, I'm a dermatologist

00:41.905 --> 00:45.885
and allergist who specializes in not just venom

00:45.885 --> 00:48.165
immunotherapy, but in everything to do

00:48.165 --> 00:49.525
with skin disease in dogs.

00:49.625 --> 00:52.325
But venom comes into our domain mainly

00:52.325 --> 00:54.645
because we are dealing with immunotherapy

00:54.865 --> 00:56.285
to pollen and dust mite.

00:56.305 --> 00:59.205
So it's one of the things that falls into the realm

00:59.205 --> 01:01.445
of the specialist in veterinary medicine.

01:01.955 --> 01:04.565
Okay. So we, we published a study, our group,

01:04.575 --> 01:06.445
which is the Animal Dermatology Clinic,

01:06.705 --> 01:09.165
and we had a, one of our young residents, Dr.

01:09.315 --> 01:10.885
Alexandra Moore, who was the,

01:11.125 --> 01:12.765
a senior author on this publication.

01:13.105 --> 01:15.405
And we took a protocol

01:15.405 --> 01:18.605
that's been used in pediatric medicine where children

01:18.905 --> 01:22.045
who are basically anaphylactic to venom

01:22.715 --> 01:25.725
have the desensitization injections given

01:25.785 --> 01:27.885
to them over a very short period of time.

01:28.345 --> 01:30.485
So I need to tell you a little bit about what used

01:30.485 --> 01:32.325
to be done in human medicine

01:32.625 --> 01:35.125
and in veterinary medicine where you would go

01:35.125 --> 01:36.685
to your allergist once a week

01:36.865 --> 01:40.565
and you would have a desensitization shot to your bee

01:40.625 --> 01:42.005
or to your wasp venom.

01:42.305 --> 01:46.525
And that would take maybe somewhere between 16 to 19 weeks

01:46.825 --> 01:50.205
of going to an allergy office to basically,

01:50.315 --> 01:53.485
have your desensitization induction performed.

01:53.905 --> 01:56.405
And then you would have injections usually once a month.

01:57.145 --> 02:00.645
So there's a protocol, several protocols in human medicine

02:00.645 --> 02:03.725
where in order to shorten the period of induction,

02:03.985 --> 02:07.285
in other words, the preliminary injections, you would

02:07.285 --> 02:11.805
therefore give the injections on either, a weekly basis

02:12.105 --> 02:13.605
or sometimes a daily basis.

02:13.825 --> 02:15.325
And there were several protocols

02:15.325 --> 02:18.765
that were published in human medicine that we adapted,

02:18.945 --> 02:21.765
for this trial, in a group of dogs.

02:22.385 --> 02:25.405
So we took, 20 dogs that were owned

02:25.665 --> 02:29.165
by people in Western Australia who had had life-threatening

02:29.765 --> 02:31.365
systemic anaphylactic reactions.

02:31.385 --> 02:34.205
So these are ranging from very small dogs

02:34.265 --> 02:37.525
to large dogs who'd experienced some very frightening

02:37.885 --> 02:41.325
reactions as a result of being stung by a bee or a wasp.

02:41.345 --> 02:45.125
But what we need to recognize is that, stings are one

02:45.125 --> 02:47.845
of the most common reasons that dogs

02:48.105 --> 02:51.925
and people die as a result of systemic exposure.

02:52.145 --> 02:54.765
So they're one of the most worrying things

02:54.765 --> 02:56.205
that we see in veterinary medicine,

02:56.205 --> 02:59.525
because if you have a dog that is allergic to thesee stings,

02:59.795 --> 03:01.125
then that can be fatal.

03:01.965 --> 03:04.025
So what happens is we took these dogs

03:04.245 --> 03:07.825
and we subjected them to, testing to prove

03:07.825 --> 03:10.505
that they were either B or wasp venom allergic.

03:11.125 --> 03:13.185
And then we, then we decided

03:13.205 --> 03:16.425
to apply this pediatric protocol to the dogs.

03:16.525 --> 03:20.225
So what we did was we used increasing doses

03:20.225 --> 03:23.905
of the venom administered under very strict medical,

03:24.405 --> 03:25.665
regulations.

03:25.725 --> 03:27.745
So these were dogs that were hospitalized

03:27.925 --> 03:29.505
and monitored very carefully,

03:30.005 --> 03:33.705
and they were given, the injections on three days,

03:34.325 --> 03:35.945
on consecutive weeks.

03:36.245 --> 03:37.305
So let me explain that.

03:37.365 --> 03:39.665
So if the dog got the injection, the first group

03:39.665 --> 03:41.905
of injections were given on the first Tuesday,

03:42.565 --> 03:44.825
the second Tuesday, and the third Tuesday,

03:45.405 --> 03:49.185
by which time they'd finished the induction protocol over a

03:49.185 --> 03:51.985
three week period where it normally would've taken 19 weeks.

03:52.765 --> 03:54.985
So there's two major advantages to that.

03:55.125 --> 03:57.065
And the major advantage is convenience,

03:57.065 --> 04:00.905
because people only have to go three times, not 19 times.

04:01.685 --> 04:05.385
But one of the major advantages that we saw with this was

04:05.695 --> 04:09.425
that the protection from the immunotherapy is happening much

04:09.425 --> 04:12.265
more rapidly because of course, everybody's very worried

04:12.265 --> 04:14.585
that if you're taking your dog out to the park,

04:15.005 --> 04:17.425
you are running along the pavement, you are playing

04:17.425 --> 04:20.305
with your dog in the outdoor environment in

04:20.305 --> 04:21.625
beautiful sunny Perth.

04:22.005 --> 04:25.385
And if the dog's stung again, then there is the risk that

04:25.385 --> 04:27.625
that reaction, could be fatal

04:27.625 --> 04:29.425
and that you could lose a much loved pet.

04:30.085 --> 04:33.545
So we were able to demonstrate that that protocol is safe.

04:33.965 --> 04:36.745
Uh, we're able to demonstrate that it appears to work.

04:37.245 --> 04:38.545
And so we're hoping

04:38.735 --> 04:42.065
that future work in this area will help us,

04:42.635 --> 04:46.625
maybe develop more, refined protocols

04:46.645 --> 04:49.545
to basically help the, the pet, the pets

04:49.545 --> 04:50.825
that are afflicted with this.

04:51.405 --> 04:53.745
So we had, what we were looking for was, we were looking

04:53.845 --> 04:56.425
to clarify that this was, this protocol was safe

04:56.425 --> 04:59.065
because there's no point using a protocol that happens

04:59.125 --> 05:01.385
to be, you know, more convenient if it

05:01.415 --> 05:02.625
puts patients at risk.

05:03.085 --> 05:04.585
And what we recognize is

05:04.585 --> 05:06.545
that if you are a human in the situation,

05:06.545 --> 05:08.385
you go into a hospital environment,

05:08.685 --> 05:12.265
you are strictly monitored during this induction phase.

05:12.725 --> 05:16.305
And we know that, it the same applies to our pets.

05:16.485 --> 05:18.025
So the results from this survey,

05:18.165 --> 05:21.705
or the results from this study rather were that the 20 dogs

05:21.705 --> 05:23.065
that we had in the study, 10

05:23.065 --> 05:24.865
of those dogs had no side effects at all.

05:25.005 --> 05:27.145
So they were hospitalized, they were monitored,

05:27.445 --> 05:29.265
and they were basically,

05:29.465 --> 05:31.745
finished the protocol without any,

05:32.255 --> 05:34.465
without any challenging things arising.

05:35.085 --> 05:38.865
We have very mild side effects in 10 other patients.

05:39.205 --> 05:41.425
So if we have a look at what those side effects were,

05:41.425 --> 05:43.145
they were ranging from,

05:43.735 --> 05:45.665
itching at the site of injections.

05:45.805 --> 05:48.825
So some local irritation where the injections were given.

05:49.605 --> 05:50.745
We were observed

05:50.745 --> 05:53.065
that I think it was approximately five

05:53.135 --> 05:54.305
dogs developed nausea.

05:54.565 --> 05:57.605
So in a dog that can't speak to you about,

05:57.635 --> 06:00.725
essentially nausea symptoms, the way that we recognize

06:00.725 --> 06:02.645
that in dogs is lip smacking.

06:02.705 --> 06:04.765
So dogs that are lip smacking

06:04.765 --> 06:07.805
because they're producing more saliva than they should,

06:07.905 --> 06:09.245
are invariably nauseous.

06:09.705 --> 06:11.485
And then we had two dogs in the study

06:11.485 --> 06:14.565
that developed diarrhea within 24 hours of,

06:14.675 --> 06:15.925
receiving the injections.

06:16.625 --> 06:19.325
So what we're saying is that these,

06:19.515 --> 06:21.525
this protocol is essentially safe

06:21.525 --> 06:23.885
because those side effects can all be managed.

06:24.025 --> 06:26.445
You can manage itching at the site of injection

06:26.445 --> 06:27.805
with antihistamine therapy.

06:28.425 --> 06:31.405
You can give dogs, anti-nausea medication

06:31.465 --> 06:33.445
before the next round of injections

06:33.745 --> 06:36.285
and diarrhea can usually obvi be obviated

06:36.425 --> 06:37.965
by modifying the diet

06:38.105 --> 06:39.885
or indeed intervening with something

06:39.885 --> 06:41.205
that's quite symptomatic.

06:41.905 --> 06:44.805
So what we're pleased to be able to report is

06:44.805 --> 06:49.605
that we didn't see any severe systemic, reactions

06:49.605 --> 06:52.125
to the desensitization, which of course is

06:52.125 --> 06:53.365
what everybody's worried about,

06:53.365 --> 06:56.085
because if you are trying to inject B venom

06:56.185 --> 06:59.045
and wasp venom back into patients that are,

06:59.355 --> 07:02.165
that are sensitized to venom, then clearly you have

07:02.165 --> 07:04.525
to be very careful that in an effort to try

07:04.525 --> 07:05.525
and get the immune system

07:05.545 --> 07:07.605
to create a self-regulatory response,

07:07.605 --> 07:08.725
that you don't actually see

07:09.115 --> 07:10.805
that you're not mimicking an allergic

07:11.285 --> 07:12.325
reaction, if that makes sense.

07:12.785 --> 07:13.845
So what, what we're saying

07:13.845 --> 07:16.565
to the pet owning public all over the world globally is

07:16.565 --> 07:18.605
that, is that there is an answer for,

07:18.745 --> 07:21.405
for anaphylactic reactions with venom and pets

07:21.405 --> 07:23.805
because it's, it, this is, this is something that perhaps,

07:24.185 --> 07:27.085
is not being necessarily, well understood

07:27.085 --> 07:29.565
that we can desensitize dogs and cats

07:29.625 --> 07:33.645
and horses to, systemic reactions to bees and ws.

07:33.645 --> 07:36.285
So we want our narrative, our messaging, is to try

07:36.285 --> 07:38.725
and, disseminate that to,

07:38.725 --> 07:40.245
the pet owning public everywhere.

07:40.425 --> 07:43.445
And that if you, if your local veterinarian isn't aware

07:43.445 --> 07:46.285
of this, then certainly the specialists in the area,

07:46.315 --> 07:47.565
will be able to help you.

07:47.745 --> 07:49.285
So you need to make,

07:49.475 --> 07:51.605
further inquiries if you are in a position

07:51.605 --> 07:53.285
where this is happening to your pet.

07:53.705 --> 07:56.765
Um, our future areas of research will be looking

07:56.785 --> 07:59.085
to see if we can further condense the induction.

07:59.105 --> 08:01.805
So what we know is that there's some ultra rush protocols

08:01.905 --> 08:05.005
in, human medicine where, children,

08:05.005 --> 08:07.845
particularly from remote communities in Western Australia

08:07.875 --> 08:09.925
that don't have access to,

08:10.415 --> 08:13.965
large major hospital facilities, can come to the central

08:14.475 --> 08:17.725
city, have their rush induction done over, say a day,

08:17.825 --> 08:20.405
and then go back to their communities without having

08:20.905 --> 08:24.125
to entail the costs of, you know, for example,

08:24.125 --> 08:25.405
longer term stays.

08:25.785 --> 08:29.365
So we wanna apply that rationale to our veterinary patients.

08:29.425 --> 08:32.645
We want to see if we can take those 10 or 11

08:32.665 --> 08:34.045
or 12 induction injections

08:34.185 --> 08:36.525
and instead of doing them over three consecutive weeks,

08:36.525 --> 08:39.605
whether we could do that in an abbreviated fashion over

08:39.605 --> 08:40.645
the course of a day.

08:41.145 --> 08:43.085
So our next steps is to,

08:43.145 --> 08:45.765
and we've had, we've got some ethics approval,

08:46.115 --> 08:49.005
pending on our next study in this area will be to look

08:49.225 --> 08:51.125
to see if we can condense that induction.

08:51.225 --> 08:54.765
So we're pretty excited. So can I just say, without wanting

08:54.785 --> 08:57.645
To sound too boastful, that the resident

08:57.645 --> 09:01.045
that presented this work at the American,

09:01.255 --> 09:05.525
conference, last year actually won the prize for,

09:05.525 --> 09:07.085
best resident research project.

09:07.225 --> 09:08.965
So we recognize that her work

09:09.305 --> 09:12.365
and our work has been, at least,

09:12.435 --> 09:15.965
made an impact in terms of the, the, the health of pets

09:15.965 --> 09:19.245
and also helping educate the veterinarians on a,

09:19.305 --> 09:20.485
on a more global scale.

09:20.625 --> 09:21.805
So we're fairly proud of that.

00:00 - What I can tell you about venom, venom and venom immunotherapy is VIT is venom immunotherapy. So what that means, it's a way that we can treat and prevent, anaphylactic reactions after repeated allergic exposure. So what we're talking about here is people, humans

00:18 - who can develop really severe anaphylactic reactions after being stung. So by bees and by wasps. And what we know in humans is that you can very effectively desensitize somebody to a bee or a wasp sting that could be life-threatening. And we can do that in dogs and cats and horses. And so I'm a veterinarian, I'm a dermatologist and allergist who specializes in not just venom immunotherapy, but in everything to do

00:48 - with skin disease in dogs. But venom comes into our domain mainly because we are dealing with immunotherapy to pollen and dust mite. So it's one of the things that falls into the realm of the specialist in veterinary medicine. Okay. So we, we published a study, our group, which is the Animal Dermatology Clinic, and we had a, one of our young residents, Dr. Alexandra Moore, who was the,

01:11 - a senior author on this publication. And we took a protocol that's been used in pediatric medicine where children who are basically anaphylactic to venom have the desensitization injections given to them over a very short period of time. So I need to tell you a little bit about what used to be done in human medicine and in veterinary medicine where you would go to your allergist once a week

01:36 - and you would have a desensitization shot to your bee or to your wasp venom. And that would take maybe somewhere between 16 to 19 weeks of going to an allergy office to basically, have your desensitization induction performed. And then you would have injections usually once a month. So there's a protocol, several protocols in human medicine where in order to shorten the period of induction, in other words, the preliminary injections, you would therefore give the injections on either, a weekly basis

02:12 - or sometimes a daily basis. And there were several protocols that were published in human medicine that we adapted, for this trial, in a group of dogs. So we took, 20 dogs that were owned by people in Western Australia who had had life-threatening systemic anaphylactic reactions. So these are ranging from very small dogs to large dogs who'd experienced some very frightening reactions as a result of being stung by a bee or a wasp.

02:41 - But what we need to recognize is that, stings are one of the most common reasons that dogs and people die as a result of systemic exposure. So they're one of the most worrying things that we see in veterinary medicine, because if you have a dog that is allergic to thesee stings, then that can be fatal. So what happens is we took these dogs and we subjected them to, testing to prove that they were either B or wasp venom allergic.

03:11 - And then we, then we decided to apply this pediatric protocol to the dogs. So what we did was we used increasing doses of the venom administered under very strict medical, regulations. So these were dogs that were hospitalized and monitored very carefully, and they were given, the injections on three days, on consecutive weeks. So let me explain that.

03:37 - So if the dog got the injection, the first group of injections were given on the first Tuesday, the second Tuesday, and the third Tuesday, by which time they'd finished the induction protocol over a three week period where it normally would've taken 19 weeks. So there's two major advantages to that. And the major advantage is convenience, because people only have to go three times, not 19 times. But one of the major advantages that we saw with this was that the protection from the immunotherapy is happening much

04:09 - more rapidly because of course, everybody's very worried that if you're taking your dog out to the park, you are running along the pavement, you are playing with your dog in the outdoor environment in beautiful sunny Perth. And if the dog's stung again, then there is the risk that that reaction, could be fatal and that you could lose a much loved pet. So we were able to demonstrate that that protocol is safe. we're able to demonstrate that it appears to work.

04:37 - And so we're hoping that future work in this area will help us, maybe develop more, refined protocols to basically help the, the pet, the pets that are afflicted with this. So we had, what we were looking for was, we were looking to clarify that this was, this protocol was safe because there's no point using a protocol that happens to be, you know, more convenient if it puts patients at risk.

05:03 - And what we recognize is that if you are a human in the situation, you go into a hospital environment, you are strictly monitored during this induction phase. And we know that, it the same applies to our pets. So the results from this survey, or the results from this study rather were that the 20 dogs that we had in the study, 10 of those dogs had no side effects at all. So they were hospitalized, they were monitored,

05:27 - and they were basically, finished the protocol without any, without any challenging things arising. We have very mild side effects in 10 other patients. So if we have a look at what those side effects were, they were ranging from, itching at the site of injections. So some local irritation where the injections were given. We were observed that I think it was approximately five

05:53 - dogs developed nausea. So in a dog that can't speak to you about, essentially nausea symptoms, the way that we recognize that in dogs is lip smacking. So dogs that are lip smacking because they're producing more saliva than they should, are invariably nauseous. And then we had two dogs in the study that developed diarrhea within 24 hours of, receiving the injections.

06:16 - So what we're saying is that these, this protocol is essentially safe because those side effects can all be managed. You can manage itching at the site of injection with antihistamine therapy. You can give dogs, anti-nausea medication before the next round of injections and diarrhea can usually obvi be obviated by modifying the diet or indeed intervening with something

06:39 - that's quite symptomatic. So what we're pleased to be able to report is that we didn't see any severe systemic, reactions to the desensitization, which of course is what everybody's worried about, because if you are trying to inject B venom and wasp venom back into patients that are, that are sensitized to venom, then clearly you have to be very careful that in an effort to try and get the immune system

07:05 - to create a self-regulatory response, that you don't actually see that you're not mimicking an allergic reaction, if that makes sense. So what, what we're saying to the pet owning public all over the world globally is that, is that there is an answer for, for anaphylactic reactions with venom and pets because it's, it, this is, this is something that perhaps, is not being necessarily, well understood

07:27 - that we can desensitize dogs and cats and horses to, systemic reactions to bees and ws. So we want our narrative, our messaging, is to try and, disseminate that to, the pet owning public everywhere. And that if you, if your local veterinarian isn't aware of this, then certainly the specialists in the area, will be able to help you. So you need to make, further inquiries if you are in a position

07:51 - where this is happening to your pet. our future areas of research will be looking to see if we can further condense the induction. So what we know is that there's some ultra rush protocols in, human medicine where, children, particularly from remote communities in Western Australia that don't have access to, large major hospital facilities, can come to the central city, have their rush induction done over, say a day, and then go back to their communities without having

08:20 - to entail the costs of, you know, for example, longer term stays. So we wanna apply that rationale to our veterinary patients. We want to see if we can take those 10 or 11 or 12 induction injections and instead of doing them over three consecutive weeks, whether we could do that in an abbreviated fashion over the course of a day. So our next steps is to, and we've had, we've got some ethics approval,

08:46 - pending on our next study in this area will be to look to see if we can condense that induction. So we're pretty excited. So can I just say, without wanting To sound too boastful, that the resident that presented this work at the American, conference, last year actually won the prize for, best resident research project. So we recognize that her work and our work has been, at least, made an impact in terms of the, the, the health of pets

09:15 - and also helping educate the veterinarians on a, on a more global scale. So we're fairly proud of that.

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