Influence of total IgE levels on the severity of sting reactions in Hymenoptera venom allergy

Sturm, Gunter J.; Heinemann, Ákos; Schuster, Christian; Wiednig, Michaela; Groselj‐Strele, Andrea; Sturm, Eva M.; Aberer, Werner

doi:10.1111/j.1398-9995.2007.01413.x

Cited by 93 publications

(93 citation statements)

References 31 publications

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“…Several studies which investigated the association of total or sIgE levels and skin test results with severe SR did not find a significant relationship among those parameters [19,27,28,40]. Total IgE levels significantly correlated with sIgE levels in our study (data not shown).…”

Section: Discussionsupporting

confidence: 60%

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Clinical Features of Children with Venom Allergy and Risk Factors for Severe Systemic Reactions

Yavuz

Şahiner²,

Büyüktiryaki³

et al. 2012

Int Arch Allergy Immunol

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Background: Severe systemic reactions (SRs) to insect venom are rare in childhood and there are few data on this study population. The aim of our study is to analyze the clinical features and to document the risk factors for severe SRs in children with insect venom allergy. Methods: Children with SRs after Hymenoptera sting were analyzed. The diagnosis was based on medical history, skin tests and/or specific IgE testing. Results: Seventy-six children were included [57 boys (75%), mean age 9.8 ± 3.4 years]. The mean age of children at the time of SR was 8.3 ± 3.4 years. Reactions were accounted for Vespula (wasp) venom in 58 (76%) and Apis mellifera (bee) venom in 18 (24%) patients. Twenty-six percent of patients had aeroallergen sensitization and 33% had atopic disease, whereas 66% had experienced previous stings. The upper limb was the most frequent area of sting (43%), and the cutaneous system (99%) was the most frequent involved system. SRs occurred in 59% of patients. Multivariate logistic regression analysis revealed eosinophilia (>5%) [odds ratio (OR) 12.6; confidence interval (CI) 1.5–109.7; p = 0.022], female sex (OR 6.4; CI 1.5–26.9; p = 0.011) and accompanying atopic disease (OR 3.4; CI 1.2–12.3; p = 0.016) as significant risk factors for severe SRs. Ninety-seven percent of patients were admitted to the emergency department; however, epinephrine was used in only 46% of patients. Conclusions: There was a high frequency of hypersensitivity to wasp venom among the study population, and severe reactions were related to mild eosinophilia, female sex and concomitant atopic diseases. A better understanding of the risk factors may lead to effective utilization of health care sources in the future.

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Section: Discussionsupporting

confidence: 60%

“…Some authors have determined male sex as a risk factor for severe SRs [17,26], whereas a considerable number of studies could not find a difference between genders [11,21,27,28]. Results of a recent study on British beekeepers revealed female sex as a predisposing factor for severe SR [29].…”

Section: Discussionmentioning

confidence: 99%

Clinical Features of Children with Venom Allergy and Risk Factors for Severe Systemic Reactions

Yavuz

Şahiner²,

Büyüktiryaki³

et al. 2012

Int Arch Allergy Immunol

View full text Add to dashboard Cite

show abstract

“…Interestingly, the frequency of bee and wasp sensitization was nearly the same, although approximately two thirds of the subjects had been stung by wasps. This is in contrast to the general population of Hymenoptera venom-allergic patients in Austria, who are mainly sensitized to wasp venom (73%) [10]. Thus, one might speculate that these asymptomatic sensitizations might originate from other sources than a Hymenoptera sting.…”

Section: Discussionmentioning

confidence: 71%

Asymptomatic Sensitization to Hymenoptera Venom Is Related to Total Immunoglobulin E Levels

Sturm¹,

Schuster²,

Kranzelbinder³

et al. 2008

Int Arch Allergy Immunol

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Background: The detection of specific serum immunoglobulin E (sIgE) to Hymenoptera venoms is an established diagnostic tool to diagnose insect venom hypersensitivity. However, the specificity of sIgE detection is a debated issue. Methods: In 145 subjects, total IgE (tIgE) and sIgE to Hymenoptera venoms as well as sIgE to rapeseed as a marker of cross-reactive carbohydrate determinants were measured. In addition, an atopy score was determined for each patient. We looked for a possible association between tIgE and the presence of sIgE in subjects with a negative history of large local or systemic reactions to insect stings. Results: Fifteen of 65 subjects (23.1%) with low levels of tIgE (<50 kU/l) had sIgE for bee or wasp venom, and 23 of 47 subjects (48.9%) with a tIgE from 50 to 250 kU/l showed sIgE. The highest rate of asymptomatic sensitization (22 of 33; 66.7%) was found in patients with tIgE levels higher than 250 kU/l. Median sIgE was approximately 4.8 times higher in subjects with tIgE levels above 250 kU/l than in those with tIgE levels <50 kU/l. Interestingly, a significant difference in median tIgE was recorded between individuals with and without sIgE to rapeseed [776.5 kU/l (25, 75% percentiles: 252.5, 2,000.0) vs. 50.5 kU/l (20.1, 172.0), respectively; p < 0001]. Conclusion: Specific antibodies are frequently seen in individuals with high tIgE, but appear to be largely irrelevant in clinical terms. This might lead to misdiagnosis in persons with an inconclusive sting history.

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“…22,36 Development of urticaria/angioedema might subsequently be inhibited by counterregulatory release of endogenous epinephrine leading to peripheral vasoconstriction. 25,33 Short time interval between sting and onset of symptoms…”

Section: The Density Of Cardiac Mast Cells Is Increased In the Settingmentioning

confidence: 99%

Over- and underestimated parameters in severe Hymenoptera venom–induced anaphylaxis: Cardiovascular medication and absence of urticaria/angioedema

Stoevesandt¹,

Hain²,

Kerstan³

et al. 2012

Journal of Allergy and Clinical Immunology

104

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Influence of total IgE levels on the severity of sting reactions in Hymenoptera venom allergy

Abstract: Patients with Hymenoptera venom allergy and high levels (>250 kU/l) of total IgE, predominantly develop grade I and grade II reactions and appear to be protected from grade III reactions. However, this hypothesis should be confirmed by extended studies with sting challenges.

Cited by 93 publications

References 31 publications

Clinical Features of Children with Venom Allergy and Risk Factors for Severe Systemic Reactions

Clinical Features of Children with Venom Allergy and Risk Factors for Severe Systemic Reactions

Asymptomatic Sensitization to Hymenoptera Venom Is Related to Total Immunoglobulin E Levels

Over- and underestimated parameters in severe Hymenoptera venom–induced anaphylaxis: Cardiovascular medication and absence of urticaria/angioedema

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