Added value of IgE detection to rApi m 1 and rVes v 5 in patients with Hymenoptera venom allergy

Insect Sting Reactions and Specific IgE to Venom and Major Allergens in a General Population

“…With an OR of >300 for sensitivity to both bee and wasp venom when having IgE to CCDs, CCD structure seems to be a very important candidate for such a common component. The additional observation that several of the DS individuals with IgE to CCDs in our unselected population had, in fact, had symptoms when stung, indicates some clinical relevance of this sensitization, although in many cases it occurs with cosensitization to other venom and pollen (especially grass) allergens [27,28]. …”

Double positivity to bee and wasp venom: Improved diagnostic procedure by recombinant allergen–based IgE testing and basophil activation test including data about cross-reactive carbohydrate determinants

“…It was thought that componentresolved diagnostics would solve the problem of double sensitivity in patients with a sensitivity to CCD, but still about 50% of these patients show sIgE antibodies to both rApi m 1 and rVes v 5. 5 It could be shown that BAT with determination of CD-sens or using submaximal doses reflects clinical symptoms (eg, after sting challenge during immunotherapy) better than other biomarkers. 12,13 Furthermore, another study showed that basophil activation with the irrelevant insect venoms was lower than with the relevant one, which was thought to be due to the weaker potential of CCDs in insect venoms to activate basophils.…”

“…It could be shown in double-positive, CCDpositive patients having sIgE antibodies to bromelain that 49% have sIgE antibodies to either rApi m 1 or rVes v 5, thus avoiding immunotherapy against both venoms in about half of these cases. 5 Another recent study showed that the use of CCD-depleted venom in BATs could detect the monosensitivity in 8 of the 18 cases with a double-positive intracutaneous test. 6 As the production of CCD-depleted venoms is difficult, we were interested in the question whether a BAT with commercially available bee and wasp venom extracts, calculation of the concentration at half-maximum stimulation (C50), and a ratio of reactivity would be helpful in solving problems with double positivity.…”

Key Issues in Hymenoptera Venom Allergy: An Update

“…In the case of wasps, it is necessary to use the allergens of the 2 insects to guarantee a good differential diagnosis [17]. The sensitivity of Api m 1 for the diagnosis with bee venom is highly variable and depends on the selection criteria for the population, the technique applied, and the type of molecule used [23][24][25][26]. In a recent study, the incorporation of new specific recombinant allergens from bee venom (Api m 2, Api m 3, Api m 4, Api m 5, and Api m 10) increased sensitivity to 95% and demonstrated that these allergens (with the exception of Api m 4) may also sensitize more than 50% of the population [8].…”