Which immunotherapy product is better for patients allergic to Polistes venom? A laboratory and clinical study

Abstract

BackgroundVenom immunotherapy (VIT) is highly effective in preventing allergic reactions to insect stings, but the appropriate venom must be used to achieve clinical protection. In patients with multiple positive results to venoms, molecular allergy diagnostics or CAP-inhibition may identify the causative venom. Concerning allergy to venom from Polistes spp. it has been proposed that only the European species P. dominulus should be used for VIT. However, this recommendation is not present in any international guideline. Using both laboratory and clinical data, we aimed to evaluate the reliability of this proposal.MethodsWe performed an in vitro study using CAP-inhibition to determine sensitization of 19 patients allergic to Polistes venom. The clinical study included 191 patients with positive tests to Polistes treated with VIT, 102 were treated with P. dominulus and 89 were treated with a mix of American Polistes (mAP).ResultsThe difference in % of inhibition was significant concerning inhibition of P. dominulus sIgE by P. dominulus venom (79.8%) compared with inhibition by mAP venom (64.2%) and not significant concerning the inhibition of mAP sIgE by P. dominulus venom (80.1%) and by mAP venom (73.6%). Instead, the clinical protection from stings was not statistically different between the two kinds of venom.ConclusionThe data from CAP inhibition would suggest that the choice of either P. dominulus venom or mAP venom for VIT is appropriate in patients with CAP inhibition higher than 70%, but the clinical data show the same odds of protection from stings using for VIT P. dominulus or mAP venom.

IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper

“…Furthermore, it is still performed to distinguish multiple sensitizations from cross-reactive sensitivities, in particular as a diagnostic tool in Hymenoptera venom allergy; however, the development of molecularbased diagnostics in allergy has significantly reduced the need of CAP inhibition performance for certain Authors, 82 while, for others, the CAP inhibition still remains fundamental. [83][84][85] ELISA assays can represent a valid alternative to FEIAs, being relatively simple and inexpensive for the assessment of serum total and specific IgE for various common allergens. Their usefulness is more greatly appreciated where ImmunoCAP is not available.…”

Management of Double Sensitization to Vespids in Europe

“…extract with regard to Polistes dominula due to the existence of low cross-reactivity between the allergens of the European (P dominula and P gallicus) and the American species (P annularis, P apachus, P exclamans, P fuscatus y P metricus) [6,43,55]. However, an Italian study has confirmed that although the cross-reactivity measured in vitro is incomplete, it did not detect differences in the protection between the immunotherapy with the mixture of American species and the immunotherapy with Polistes dominula following spontaneous stings [56]. Due to limitations in design, specific efficacy studies are needed in the European population to confirm this finding.…”

Hymenoptera Venom Allergy: Management of Children and Adults in Clinical Practice

“…As for VIT with Polistes venom, the use of P dominula venom to treat European patients should be preferred, since American Polistes venom extracts have been reported to lack a protective effect [6,169]. However, a recent study [170], in which incomplete in vitro cross-reactivity was confirmed, did not detect differences in clinical protection between VIT with a mixture of American Polistes -Simultaneous testing of the same concentration of more venoms is to be preferred. The next concentration should only be tested afterwards.…”