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

Eberlein, Bernadette; Krischan, Lilian; Darsow, Ulf; Ollert, Markus; Ring, Johannes

doi:10.1016/j.jaci.2012.02.008

Cited by 131 publications

(113 citation statements)

References 20 publications

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“…Importantly, when we analyzed BAT double-positive patients in whom a single insect causing an allergic reaction has been identified, we showed a markedly higher basophil response to the culprit venom than to the clinically irrelevant venom. Similar observations were recently demonstrated by Eberlein et al [19] which showed a much stronger basophil reaction to the clinically relevant insect venom than to the irrelevant one in double IgE-positive patients. On the other hand, in cases with double-positive intradermal tests, there was no correlation with a single culprit insect, and similar observations were also demonstrated by Eberlein et al [19].…”

Section: Discussionsupporting

confidence: 90%

Clinical Routine Utility of Basophil Activation Testing for Diagnosis of Hymenoptera-Allergic Patients with Emphasis on Individuals with Negative Venom-Specific IgE Antibodies

Korošec¹,

Šilar²,

Eržen³

et al. 2013

Int Arch Allergy Immunol

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Background: Previous reports suggest the usefulness of basophil activation testing (BAT) in Hymenoptera-allergic patients with negative venom-specific IgE antibodies. We sought to evaluate the diagnostic utility of this testing in a routine clinical laboratory setting. Materials and Methods: Twenty-one patients with anaphylactic reactions to Hymenoptera sting (median grade III) and negative venom-specific IgE were routinely and prospectively tested with BAT. Results: We were able to diagnose 81% (17 of 21) of patients with BAT and 57% (12 of 21) with intradermal skin testing. Three wasp venom-allergic patients showed IgE positivity to rVes v 5. Four patients (19%) were negative for all tests. In the case of double-positive BAT, the culprit insect correlated with the venom that induced a significantly higher basophil response. Conclusions: BAT allows the identification of severe Hymenoptera-allergic patients with negative specific IgE and skin tests. The routine use of this cellular test should facilitate prescription of venom immunotherapy in complex cases with inconclusive diagnostic results.

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Section: Discussionsupporting

confidence: 90%

Clinical Routine Utility of Basophil Activation Testing for Diagnosis of Hymenoptera-Allergic Patients with Emphasis on Individuals with Negative Venom-Specific IgE Antibodies

Korošec¹,

Šilar²,

Eržen³

et al. 2013

Int Arch Allergy Immunol

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“…Api m 3 and Api m 10 allergenic components are expected on the market soon, which should raise the sensitivity of BV diagnosis to 87.5%. 40,41 in HVA patients with mastocytosis but also, in consequence, constitutes an obligatory indication for tryptase tests and diagnostic workup for primary mast-cell disorders in all HVA patients who present with cardiovascular symptoms and hypotonia after a sting. However, it must be stressed that in light of the recent reports, mastocyte disorders may also be suspected in patients presenting with a SAR with hypotension and showing no skin symptoms (urticaria, angioedema) irrespective of tryptase levels.…”

Section: Tablementioning

confidence: 99%

Insect sting allergy in adults: key messages for clinicians

Nittner-Marszalska¹,

Cichocka‐Jarosz²

2015

Polish Archives of Internal Medicine

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In most affected persons, a Hymenoptera sting results in local itching and mild induration. There are some individuals, however, who additionally respond to a sting by developing sensitization manifested by the presence of venom-specific immunoglobulin E (IgE) antibodies (vsIgE) to various components of insect venoms (in honeybee venom, 12 allergens have been identified so far: Api m1 -Api m 12; in wasp venom, 5 allergens have been identified: Vesp v 1, V v 2, Vesp v 3, Vesp v5, and Ves v 6). 2 Venom sensitization is the key factor for but is not synonymous with venom allergy. Sensitization to Hymenoptera venoms may be asymptomatic (hypersensitivity not clinically relevant) or symptomatic defined as Hymenoptera--venom allergy (HVA). The asymptomatic sensitization is common and found in 9.3% to 40.7% of the general population and in 30% to 60% of beekeepers (which reflects the effect of exposition toThe occurrence of Hymenoptera-venom allergy Allergic reactions to insect bites result most frequently from stings of flying insects of the Hymenoptera order. From among over 100 000 species of Hymenoptera, the ones mainly responsible for sting reactions are usually honeybee (Apis mellifera) as well as wasps and hornets (eg, Vespula germanica, V. vulgaris, V. rufa, Vespae sp.). However, potential perpetrators of Hymenoptera allegry are diverse and vary with geography. In southern Europe, there are paper wasps (Polistinae subfamilies); in the United States, there are fire ants (Solenopsis invicta); and in Australia, there are Jack jumper ants (Myrmecia pilosula) that seem to cause more problems. A large number of Hymenoptera species, their ways of feeding, and their aggressive defense behavior result in as many as 56.6% to 94.5% of people experiencing at least 1 sting in their lives. ABSTRACTDuring their lifetime, 94.5% of people are stung by wasps, honeybees, hornets, or bumble-bees (order Hymenoptera). After a sting, most people show typical local symptoms, 5% to 15% develop local allergic reactions, and 3% to 8.9%-systemic allergic reactions (SARs), which may be potentially life-threatening in about 10% of them. In mild forms of Hymenoptera-venom allergy (HVA), the leading symptoms are urticaria and edema (grades I and II, respectively, according to the Mueller classification). Severe SARs are classified as grade III (respiratory symptoms) and IV (cardiovascular symptoms). Rare manifestations of HVA are Kounis syndrome and takotsubo cardiomyopathy. All patients after an SAR require standard (skin test, IgE, tryptase) or comprehensive (component diagnosis, basophil activation test) allergy testing. All patients with severe systemic symptoms (hypertension, disturbances in consciousness) should be tested for mastocytosis. Additionally, a relationship was found between the severity of HVA symptoms and intake of angiotensin-converting enzyme inhibitors (ACEIs). There is a similar concern, although less well-documented, about the use of β-blockers. Patients with HVA who have experienced a SAR are potential candidates for ...

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“…Immunologic testing (e.g., specific IgE tests, basophil activation test, horseradish peroxidase, etc.) may help with identification and immunotherapy may provide therapeutic and quality of life benefits (Boyle et al 2012, Eberlein et al 2012). An even more intriguing observation for clinical allergists is that the majority of cases (73%) in this series of deaths were alive at the time they arrived for medical care.…”

Section: Resultsmentioning

confidence: 99%

Case series of 23 deaths from Hymenoptera stings among United States Air Force populations

Voss¹,

Kugblenu²,

Salter³

et al. 2016

JHR

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Medical conditions arising from hymenopteran sting allergy or mass envenomation are a serious health concern, particularly in austere environments. Both practicing allergists and entomological pest control personnel should consider the relevance of stinging insects when responding to problems with Hymenoptera. Recent occupational reviews of civilian deaths from insect bites and stings prompted our review of the US Air Force Mortality Registry to determine the relevance of insect stings and bites as a cause of death in the US Air Force. After reviewing over 40 years of death records we identified 23 death records, among US Air Force Active duty, guard, or retirees that arose directly from hymenopteran stings.

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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

Cited by 131 publications

References 20 publications

Clinical Routine Utility of Basophil Activation Testing for Diagnosis of Hymenoptera-Allergic Patients with Emphasis on Individuals with Negative Venom-Specific IgE Antibodies

Clinical Routine Utility of Basophil Activation Testing for Diagnosis of Hymenoptera-Allergic Patients with Emphasis on Individuals with Negative Venom-Specific IgE Antibodies

Insect sting allergy in adults: key messages for clinicians

Case series of 23 deaths from Hymenoptera stings among United States Air Force populations

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