Safety of Repeated Imported Fire Ant Ultra-Rush Protocols

Treatment of imported fire ant (IFA) hypersensitivity includes avoidance and venom immunotherapy (VIT) that reduces the risk of reactions to less than 5%. Previous studies have shown that rush immunotherapy (RIT) is safe and efficacious. It is unknown if multiple RIT procedures on individuals with breaks in VIT are safe and effective. This is a retrospective chart review of three patients who have undergone six IFA VIT rush protocols at our institution. Patients were all female with a median age of 27 years. All are active duty service members without medical problems who reside in an IFA endemic area. Reviewed protocols consisted of 10 injections of IFA whole body extract given in 1 day. Local reactions were the only side effect noted. All patients completed the protocols without further incident. Following each protocol, median VIT adherence was 9 months (range 2-72 months). Reasons for stopping VIT were deployment and pregnancy. Non-adherence is common and leads to breaks in VIT. The risk of VIT resumption in patients with previous RIT or VIT is unknown. This case series illustrates the safety and efficacy of repeated IFA VIT rush procedures in patients who for personal and service related reasons had breaks in VIT.