Discontinuation of yellow jacket venom immunotherapy: Follow-up of 75 patients by means of deliberate sting challenge

Halteren, Henk K. van; Linden, P.-W. G. Van Der; Burgers, Jacobus A.; Bartelink, A. K. M.

doi:10.1016/s0091-6749(97)70271-9

Cited by 51 publications

(45 citation statements)

References 26 publications

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“…Similar findings on the BAT to constitute a potential diagnostic tool in patients with negative IgE and skin test results were recently observed by Kosnik et al (30). (20)(21)(22)(23)(24)(25)(26). In our cross-sectional analysis, only 18% of the patients demonstrated negative wasp venom IgE after 3 years of treatment.…”

Section: Discussionmentioning

confidence: 87%

Flow‐assisted quantification of in vitro activated basophils in the diagnosis of wasp venom allergy and follow‐up of wasp venom immunotherapy

Ebo

Hagendorens

Schuerwegh

et al. 2006

Cytometry Part B Clinical

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Background: Correct identification of the culprit venom is a prerequisite for specific venom immunotherapy (VIT). Despite the efficacy of VIT, issues as how to monitor treatment and when to discontinue maintenance therapy remain to be established.Methods: To evaluate diagnostic performances of the basophil activation test (BAT) in wasp venom allergy, 80 patients with a definite history of wasp venom anaphylaxis (systemic reactors) and 14 waspstung asymptomatic controls (stung controls) were enrolled. Venom-induced basophil activation was analyzed flow cytometrically by double-labeling with anti-IgE and anti-CD63. Results were compared to wasp IgE levels and results of a venom skin test (VST). To establish whether the BAT constitutes a candidate marker to monitor VIT, the BAT was repeated in 22 patients on the 5th day of a build-up course and after 6 months of maintenance VIT. Whether the BAT could contribute in the decision of discontinuing VIT was assessed in a cross-sectional analysis in 30 patients receiving treatment for 3 years.Results: Comparison between systemic reactors and stung controls revealed a sensitivity of 86.4% and specificity of 100% for venom IgE, and sensitivity of 81.8% for VST, respectively. In contrast to stung controls, patients demonstrated dose-dependent venom-induced basophil activation. The BAT attained a sensitivity of 83.8% and specificity of 100%. At the end of the build-up course, no effect of VIT on the BAT was demonstrable. When the BAT was repeated after 6 months of treatment, submaximal stimulation of the cells demonstrated a significant decreased CD63 expression (P < 0.04). Patients having VIT for 3 years also demonstrated significantly lower venom-induced CD63 expression (P < 0.001). After 3 years, 60% of the patients had a negative BAT for submaximal stimulation of the cells whereas only 17.9% of the patients had negativation of wasp IgE.Conclusions: The BAT is a reliable instrument for the diagnosis of wasp venom anaphylaxis and might constitute an instrument to monitor wasp VIT. q

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Section: Discussionmentioning

confidence: 87%

Flow‐assisted quantification of in vitro activated basophils in the diagnosis of wasp venom allergy and follow‐up of wasp venom immunotherapy

Ebo

Hagendorens

Schuerwegh

et al. 2006

Cytometry Part B Clinical

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“…117 VIT is associated with a significant increase in specific IgG antibodies that has initially been suggested as a marker of effectiveness 122 ; these immunological changes induced by VIT were also reported in honeybee venom-allergic children. 123 The subclass of IgG antibodies is usually restricted to IgG1 and IgG4.…”

Section: Specific Ige and Igg4 Levelsmentioning

confidence: 82%

“…98 Other studies concluded that the grade of the SSR prior to VIT was not relevant to the probability of a relapse. 112,117 Although it is still controversial whether severe initial SSR is a risk factor for relapse, it has been agreed that those patients are at greater risk for severe SSR when they relapse. higher baseline tryptase and therapy failure, 31 and 86% of 50 mastocytosis patients were protected after initiation of VIT.…”

Section: Severity Of Reaction Prior To Vitmentioning

confidence: 99%

“…In adults, a sting challenge can be recommended as the most reliable method to evaluate effectiveness of VIT IV C Weak based on case series studies 101,117 Van Halteren 1997 117 Golden 1996 Safety of VIT in adults and children with concomitant disease such as cardiovascular disease Observational trials Medium prediction of tolerance for subsequent field stings. 119 On the other hand, it has been shown that 21% of patients not treated with VIT, who initially tolerated a sting challenge, had systemic symptoms after a second challenge.…”

Section: Strength Of Recommendation Other Considerations Key Referencesmentioning

confidence: 99%

“…120 The reliability of early sting challenges to monitor effectiveness of VIT appears to be high, 121 although repeated sting challenges during three to five years after treatment identified 8%-10% of patients who relapsed. 101,117 Importantly, tolerated sting challenges can improve health-related QoL, especially in patients reporting high impairment of health-related QoL before the sting challenge. 51 Thus, sting challenges should not only be seen in the context of evaluating effectiveness but also in terms of fostering individual belief in disease-specific safety.…”

Section: Strength Of Recommendation Other Considerations Key Referencesmentioning

confidence: 99%

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EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

Sturm

Varga

Roberts

et al. 2017

Allergy

383

528

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Hymenoptera venom allergy is a potentially life‐threatening allergic reaction following a honeybee, vespid, or ant sting. Systemic‐allergic sting reactions have been reported in up to 7.5% of adults and up to 3.4% of children. They can be mild and restricted to the skin or moderate to severe with a risk of life‐threatening anaphylaxis. Patients should carry an emergency kit containing an adrenaline autoinjector, H1‐antihistamines, and corticosteroids depending on the severity of their previous sting reaction(s). The only treatment to prevent further systemic sting reactions is venom immunotherapy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Venom Immunotherapy as part of the EAACI Guidelines on Allergen Immunotherapy initiative. The guideline aims to provide evidence‐based recommendations for the use of venom immunotherapy, has been informed by a formal systematic review and meta‐analysis and produced using the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included representation from a range of stakeholders. Venom immunotherapy is indicated in venom‐allergic children and adults to prevent further moderate‐to‐severe systemic sting reactions. Venom immunotherapy is also recommended in adults with only generalized skin reactions as it results in significant improvements in quality of life compared to carrying an adrenaline autoinjector. This guideline aims to give practical advice on performing venom immunotherapy. Key sections cover general considerations before initiating venom immunotherapy, evidence‐based clinical recommendations, risk factors for adverse events and for relapse of systemic sting reaction, and a summary of gaps in the evidence.

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P38 mitogen‐activated protein kinase signal transduction in the diagnosis and follow up of immunotherapy of wasp venom allergy

Verweij

Knop

Bridts

et al. 2010

Cytometry Part B Clinical

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Background: P38 mitogen-activated protein kinase (MAPK) is known to govern IgE-mediated basophil activation. Intracellular phosphorylated p38 MAPK (Pp38 MAPK) in IgE-activated basophils can be quantified flow cytometrically.Objectives: To study whether Pp38 MAPK constitutes a potential novel read-out for flow-assisted diagnosis of hymenoptera venom allergy and to investigate whether this marker allows follow-up of successful venom immunotherapy (VIT).Methods: Fifty-two patients with documented wasp venom allergy and seven wasp-stung asymptomatic control individuals were enrolled. Wasp venom-induced basophil activation was analyzed flow cytometrically with anti-IgE, anti-CD63, and anti-Pp38 MAPK to assess their activation status before starting immunotherapy. To assess whether p38 MAPK constitutes a candidate marker for monitoring VIT, we repeated the basophil activation test (BAT) in 25 patients on the fifth day of a build-up immunotherapy. In addition, we investigated whether the Pp38 MAPK-based BAT could contribute in the decision of discontinuing VIT in a cross-sectional analysis in 13 patients receiving treatment for 3 years and 14 patients receiving treatment for 5 years.Results: Patients exhibited a dose-dependent basophil activation with phosphorylation of p38 MAPK and upregulation of downstream CD63. In contrast, stung controls demonstrated a dose-dependent but ''abrogated'' signal transduction in basophils with less and shorter duration of the phosphorylation of p38 MAPK and without subsequent upregulation of CD63. When repeated after 5 days of VIT and when investigated cross-sectionally after 3 years or 5 years of maintenance therapy, no effect of VIT on the phosphorylation of p38 MAPK was demonstrable.Conclusions: This study discloses that not only basophils from patients, but also from the stung control individuals, respond to wasp venom stimulation with phosphorylation of p38 MAPK, although to a lesser extend. No clear effect of VIT on the phosphorylation of p38 MAPK was shown. Thus, although p38 MAPK provides an additional tool in the diagnosis of wasp venom allergy, it does not contribute to the decision whether to stop successful VIT.

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Discontinuation of yellow jacket venom immunotherapy: Follow-up of 75 patients by means of deliberate sting challenge

Cited by 51 publications

References 26 publications

Flow‐assisted quantification of in vitro activated basophils in the diagnosis of wasp venom allergy and follow‐up of wasp venom immunotherapy

Flow‐assisted quantification of in vitro activated basophils in the diagnosis of wasp venom allergy and follow‐up of wasp venom immunotherapy

EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

P38 mitogen‐activated protein kinase signal transduction in the diagnosis and follow up of immunotherapy of wasp venom allergy

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