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Aktuelle Dermatologie 2022; 48(06): 267-270
DOI: 10.1055/a-1660-4731
Fehler und Irrtümer in der Dermatologie

Wespe statt Biene – Akzidentelle Neusensibilisierung auf Wespengift unter Immuntherapie mit Bienengift

Wasp Instead of Bee – Accidental de novo Sensitization with Wasp Venom during Immunotherapy with Bee Venom
Andreas J. Bircher
1   Allergologie, Universitätsspital Basel, Schweiz
2   Facoltà di scienze biomediche, Università della Svizzera italiana, Lugano, Schweiz
,
David Spoerl
3   Service d'immunologie et d'allergologie, Département de médecine, Hôpitaux Universitaires de Genève, Genève, Schweiz
,
Kathrin Scherer Hofmeier
4   Allergologie, Dermatologie, Kantonsspital Aarau, Schweiz
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Zusammenfassung

Während einer laufenden Immuntherapie mit Bienengift bei einer auf Bienengift monosensibilisierten Patientin wurde im 3. Jahr irrtümlicherweise eine Erhaltungsdosis Wespengift verabreicht. Es traten keine unmittelbaren Nebenwirkungen auf, hingegen konnte nach einigen Wochen ein Anstieg der initial negativen wespengiftspezifischen IgE- und IgG-Antikörper dokumentiert werden. Es muss somit von einer aktiven Sensibilisierung durch die hohe Einmaldosis Wespengift ausgegangen werden. Die Immuntherapie mit Bienengift konnte nach der empfohlenen Dauer von 5 Jahren vollendet werden. Eine akzidentelle nachweislich aktive Sensibilisierung auf ein Allergen ist sehr selten, dürfte aber einen Verstoß gegen die Pflichten aus dem Behandlungsvertrag darstellen und möglicherweise sogar den Tatbestand der Körperverletzung erfüllen. Die permanente Schädigung kann rechtlich schwerer wiegen als ein einmaliger Dosierungsfehler. Die strikte Anwendung von Leitlinienempfehlungen ist zur Vermeidung von systematischen und menschlichen Fehlern unabdingbar.

Abstract

In a patient monosensitized to bee venom, a maintenance dose of wasp venom was erroneously administered in the 3rd year during her ongoing immunotherapy with bee venom. There were no immediate side effects, but after a few weeks an increase of the initially negative wasp venom specific IgE and IgG antibodies could be documented. Thus, an active sensitization by the high single dose of wasp venom must be assumed. Immunotherapy with bee venom could be completed after the recommended duration of 5 years. Accidental demonstrable active sensitization to an allergen is very rare but is likely to constitute a breach of obligations under the treatment contract, and may even constitute a body injury. Permanent injury may be legally more serious than a one-time dosing error. Strict application of guideline recommendations is essential to avoid systematic and human errors.



Publication History

Article published online:
08 March 2022

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