{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:45:12Z","timestamp":1792626312129,"version":"4.5.0"},"reference-count":36,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004267","name":"Royal Adelaide Hospital","doi-asserted-by":"publisher","award":["99\u201005\u201052\u201005\u201019"],"award-info":[{"award-number":["99\u201005\u201052\u201005\u201019"]}],"id":[{"id":"10.13039\/501100004267","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004267","name":"Royal Adelaide Hospital","doi-asserted-by":"publisher","award":["100\u201005\u201052\u201005\u201019"],"award-info":[{"award-number":["100\u201005\u201052\u201005\u201019"]}],"id":[{"id":"10.13039\/501100004267","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010882","name":"Australasian Society of Clinical Immunology and Allergy","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010882","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012503","name":"Royal Hobart Hospital Research Foundation","doi-asserted-by":"publisher","award":["18\u2010105"],"award-info":[{"award-number":["18\u2010105"]}],"id":[{"id":"10.13039\/100012503","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Experimental Allergy"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Jack Jumper ant (JJA) venom immunotherapy (VIT) is highly efficacious but the lowest effective dose is unknown. Delta\u2010inulin adjuvant (Advax) is known to enhance honeybee VIT immunogenicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This phase 1\/2 single\u2010blind, randomised controlled trial aimed to compare the efficacy and safety of JJA VIT with different doses of venom \u00b1 Advax.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adults aged 18\u201365 with a history of immediate systemic reaction (SR) to JJA stings were randomised to receive JJA VIT at a maintenance dose of 25\u2009mcg or 50\u2009mcg\u2009\u00b1\u2009Advax; participants were blinded to treatment allocation. Primary outcomes were the response to sting challenges after 12\u2009months and venom\u2010specific IgE and IgG4 responses to treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty\u2010nine of 50 screened subjects met inclusion criteria and were randomised; 44 started treatment (25\u2009mcg\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200912; 25\u2009mcg\u2009+\u2009Advax\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913; 50mcg\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200912, 50\u2009mcg\u2009+\u2009Advax\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200912). Subsequently, two withdrew due to SRs to treatment, and two withdrew due to unrelated factors. The higher JJA venom maintenance dose was associated with reduced likelihood of SRs (OR 0.53 (95% CI, 0.28\u20130.98)), while Advax did not have an effect (OR 1.17 (95% CI, 0.59\u20132.32)). Forty proceeded to sting challenge, with six developing SRs. There was no difference between groups for sting challenge outcome (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.98), and the ORs for 25\u2009mcg vs. 50\u2009mcg venom dose (0.89, 95% CI, 0.38\u20132.09) and Advax vs. no Advax (0.99, 95% CI 0.42\u20132.33) indicated no effect. There were no differences between groups for venom sIgE (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.78), sIgG4 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.25), sIgE\/IgG4 ratio (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.42), intradermal (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.77), and basophil activation test (BAT) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.69) responses to treatment. Subjects with high baseline BAT sensitivity, which reduced markedly in response to treatment, were less likely to have a positive sting challenge (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Challenge outcomes were similar for all groups, with no significant difference found between 25 and 50\u2009mcg maintenance dose or between treatment with and without Advax. Further research of low dose JJA VIT is warranted to confirm its efficacy and tolerability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>NCT03066986<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cea.70261","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T20:15:42Z","timestamp":1773000942000},"page":"378-390","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Pilot Randomised Controlled Dose\u2010Ranging Trial of Ant Venom Immunotherapy With and Without Delta\u2010Inulin Adjuvant"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8205-865X","authenticated-orcid":false,"given":"Thanh\u2010Thao Adriana","family":"Le","sequence":"first","affiliation":[{"name":"Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program Royal Hobart Hospital  Hobart Tasmania Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy","family":"Wanandy","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program Royal Hobart Hospital  Hobart Tasmania Australia"},{"name":"College of Health and Medicine, University of Tasmania  Hobart Tasmania Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Griffith B.","family":"Perkins","sequence":"additional","affiliation":[{"name":"Immunology Directorate, SA Pathology  Adelaide Australia"},{"name":"Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital  Adelaide Australia"},{"name":"Adelaide Medical School, University of Adelaide  Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Lester","sequence":"additional","affiliation":[{"name":"Rheumatology Research Group, Basil Hetzel Institute  Woodville South South Australia Australia"},{"name":"Discipline of Medicine, University of Adelaide  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wun Yee","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program Royal Hobart Hospital  Hobart Tasmania Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malcolm","family":"Turner","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program Royal Hobart Hospital  Hobart Tasmania Australia"},{"name":"College of Health and Medicine, University of Tasmania  Hobart Tasmania Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Woodman","sequence":"additional","affiliation":[{"name":"Flinders Centre for Epidemiology and Biostatistics, Flinders University  Bedford Park South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily M.","family":"Mulcahy","sequence":"additional","affiliation":[{"name":"Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program Royal Hobart Hospital  Hobart Tasmania Australia"},{"name":"College of Health and Medicine, University of Tasmania  Hobart Tasmania Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherin Vareeckal","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Immunology Royal Melbourne Hospital and North Western Mental Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shweta","family":"Mhatre","sequence":"additional","affiliation":[{"name":"Immunology Directorate, SA Pathology  Adelaide Australia"},{"name":"Adelaide Medical School, University of Adelaide  Adelaide Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon G. 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