A comparative study of IgG subclass antibodies in patients allergic to wasp or bee venom

Abstract

IgG1 and IgG4 antivenom antibody responses were compared in groups of patients who had experienced systemic reactions to wasp (Vespula spp.) or bee stings. Pretreatment serum IgG4 antibody levels were low in both groups, but IgG1 antibodies were significantly raised in bee-allergic patients (P < 0.002), probably reflecting their greater exposure to stings than wasp-reactive patients. No direct or indirect relationships were found, in untreated bee or wasp patients, between IgG1, IgG4, or IgE antibody levels and the severity of a patient's last systemic reaction to a sting. After a 12-week course of venom immunotherapy (VIT), IgG1 antibodies increased significantly only in wasp-sensitive patients (P < 0.001), although both groups responded with marked increases in venom-specific IgG4 (P < 0.01). Wasp-allergic subjects who responded to VIT with high production of specific IgG4 showed the greatest increases (pre- to post-VIT) in IgE antibodies (P < 0.05). This group also demonstrated a direct correlation (P < 0.05) between post-VIT levels of IgE and IgG1 antibodies, a finding contrary to an IgE-immunoregulatory role for IgG1. High levels of venom-specific IgG1 alone, or in combination with IgG4, were not protective in three patients who suffered repeated adverse reactions to bee VIT, showing that absolute levels of IgG subclass antivenom antibodies are not reliably indicative of clinical responsiveness in individual patients.

Human Allergen-Specific IgG Subclass Antibodies Measured Using ImmunoCAP Technology

“…The IgG3 and IgG4 antibody levels were low at the start of VIT, but later the venom-specific IgG4 increased dramatically, which is typical of successful VIT treatments [10,31] . No major changes were generally ob-served for the other IgG subclasses, but an increase in specific IgG1 was observed in some patients, as reported by others [32] . Only minor changes in specific IgE were seen in some of the patients.…”

The frequency and clinical significance of specific IgE to both wasp (Vespula) and honey‐bee (Apis) venoms in the same patient

“…The level of IgE to venom does not reliably reflect the severity of the last reaction [3,23,27,28] and this is confirmed in our study of double-positive patients, where the same proportion (50%) of vespula-allergic patients with specific IgE of class 2 and below, or class 3 and above, were candidates for desensitization therapy. Whether the level of venom-specific IgE or IgG is a predictor of subsequent reactivity is still controversial [1,3,[29][30][31][32][33][34], but there is little evidence in this cohort of frequent clinical sensitivity to both venoms in double-positive patients.…”

Clinical immunology review series: an approach to desensitization

“…The precise role of the antibodies is controversial; they are proposed to bind to the allergen and prevent its causing mast cell degranulation via IgE binding. Levels of allergen-specific IgG (total IgG or IgG4) do not predict or correlate with a clinical response to immunotherapy [74][75][76][77].…”