Randomized controlled trial demonstrating the benefits of delta inulin adjuvanted immunotherapy in patients with bee venom allergy

J Allergy Clin Immunol. 2019 Aug;144(2):504-513.e16. doi: 10.1016/j.jaci.2019.03.035. Epub 2019 Jul 9.


Background: Allergic reactions to Hymenoptera insect stings remain a major global clinical problem. Although effective, parenteral desensitization regimens require use of costly venom extracts and require frequent visits over extended periods of time.

Objective: Adjuvants are commonly used to enhance the efficacy of infectious disease vaccines, and this study asked whether Advax (Vaxine Pty Ltd, Adelaide, Australia), a novel noninflammatory polysaccharide adjuvant, might provide similar benefits for allergy desensitization.

Methods: A randomized, controlled phase 1/2 trial was undertaken in 27 adults with a history of rapid-onset systemic allergic reactions to honeybee stings and positive specific IgE levels to evaluate the safety and efficacy of honeybee venom immunotherapy (HBVIT) combined with Advax adjuvant. Venom immunotherapy (VIT) was administered monthly for 30 months after achievement of maintenance doses.

Results: Advax-adjuvanted HBVIT was well tolerated. Around week 14 of VIT, specific IgG4 responses peaked in both groups but increased earlier, peaked higher, and were better maintained through the end of the study in the Advax-adjuvanted arm. Several different patterns of serologic response to VIT were seen; some subjects had a dominant IgG4 response, some had a combined IgG4 and IgG1 response, and some had an exclusively IgG1 response. In some subjects specific IgE levels increased during the induction phase and then decreased, whereas in others specific IgE levels progressively decreased from the start of VIT.

Conclusion: Advax adjuvant favorably enhanced the immunogenicity of HBVIT, with an early and prolonged switch to specific IgG4 production. The ability of Advax adjuvant to enhance VIT efficacy warrants further study.

Keywords: Hymenoptera; IgG(4); adjuvant; allergy; anaphylaxis; immunotherapy; inulin.

Publication types

  • Clinical Trial, Phase I
  • Clinical Trial, Phase II
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adjuvants, Immunologic / administration & dosage*
  • Adult
  • Aged
  • Bee Venoms / administration & dosage*
  • Female
  • Humans
  • Hypersensitivity* / immunology
  • Hypersensitivity* / pathology
  • Hypersensitivity* / therapy
  • Immunoglobulin E / immunology*
  • Immunotherapy*
  • Insect Bites and Stings* / immunology
  • Insect Bites and Stings* / pathology
  • Insect Bites and Stings* / therapy
  • Inulin / administration & dosage
  • Inulin / analogs & derivatives*
  • Male
  • Middle Aged


  • Adjuvants, Immunologic
  • Bee Venoms
  • delta inulin
  • Immunoglobulin E
  • Inulin

Associated data

  • ANZCTR/ACTRN12608000379314