Intracutaneous Skin Tests and Serum IgE Levels Cannot Predict the Grade of Anaphylaxis in Patients with Insect Venom Allergies

Hollstein, Moritz M.; Matzke, Silke S; Lorbeer, Lisa; Forkel, Susann; Fuchs, Thomas; Lex, Christiane; Buhl, Timo

doi:10.2147/jaa.s367272

Cited by 7 publications

(9 citation statements)

References 51 publications

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“…Hence, subjects with low skin reactivity (i.e., those who required a high venom dosage to induce wheals) generally displayed low venom-specific IgE levels. In our previous study of the same cohort, we were able to show that grade IV anaphylaxis was associated with lower venom-specific IgE levels [23]. We therefore deduced that there was a correlation between venom concentration, venom-specific IgE levels, and the severity of anaphylaxis, which was largely independent of wheal area.…”

Section: Discussionmentioning

confidence: 68%

“…In case more than one visit/data point was available for a specific patient, the value with a date closest to AIT initiation was chosen. Additional details for this patient cohort, including comorbidity and drug use, have been published [23]. To ensure comparability between ICTs performed using different venom concentrations, we selected a single venom concentration (0.1 μg/ mL), as this venom concentration elicited a first positive ICT result in the majority of study participants.…”

Section: Discussionmentioning

confidence: 99%

“…Anaphylactic reactions were graded according to Mueller's severity score [24]. The recording of patient history, and laboratory testing and evaluation were performed as previously described [23]. We determined venom-specific IgG, IgG4, and IgE, total IgE, tryptase, and IgE specific to a mixture of common inhalant allergens (Phadiatop, sx1), using the ImmunoCAP system (Thermo Fisher, Waltham, MA, USA) following the manufacturer's instructions.…”

Section: Grading Severity Of Anaphylaxis and Serologymentioning

confidence: 99%

“…material, see www.karger.com/doi/10.1159/000529801). The same patient cohort had previously been studied to investigate factors influencing the severity of anaphylaxis in the context of bee and vespid allergies [23]. Prior to study initiation, the study outline was reviewed and approved by the Local Ethics Committee, approval number [1/11/21].…”

Section: Study Participantsmentioning

confidence: 99%

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Skin Tests versus Serology: Specific IgE May Suffice for Diagnosis of Vespid Venom Allergy and Follow-Up of Allergen Immunotherapy

Hollstein

Matzke

Lorbeer

et al. 2023

Int Arch Allergy Immunol

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Introduction: In adults, allergic reactions to insect stings are among the most frequent causes of anaphylaxis, a potentially life-threatening condition. Recurrent anaphylaxis following vespid stings may be prevented by allergen immunotherapy (AIT). The aim of this study was to evaluate the benefit of measuring venom-induced wheal area in intracutaneous skin tests (ICT), in comparison to various serological and clinical parameters, for the diagnosis of severe vespid venom allergy and during follow-up of AIT. Methods: We conducted a monocentric, retrospective evaluation of 170 patients undergoing AIT against vespid venoms. We scanned ICT wheals at baseline and at three time points after AIT initiation and measured wheal area using objective data analysis software. Results: We found that ICT histamine-induced and venom-induced wheal areas did not correlate. In addition, the venom-induced wheal area was independent from the minimal venom concentration required to elicit a wheal in an ICT and all other parameters. No correlation was found between wheal area and the severity of anaphylaxis. Wheal area standardized to the application of 0.1 μg/mL venom inversely correlated with anaphylaxis severity and positively correlated with venom-specific IgE levels. During AIT, mean areas of venom-induced wheals did not change. In contrast, venom-specific IgG and IgG4 levels, and the minimal venom concentration required to induce a positive ICT result increased, while the venom wheal area standardized to 0.1 μg/mL venom application and specific IgE levels decreased over time. Conclusion: Wheal area evaluation did not provide additional information over specific IgE analysis. We therefore recommend that ICTs are used only as a secondary measure for confirming serological test results.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Grading Severity Of Anaphylaxis and Serologymentioning

confidence: 99%

Section: Study Participantsmentioning

confidence: 99%

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Skin Tests versus Serology: Specific IgE May Suffice for Diagnosis of Vespid Venom Allergy and Follow-Up of Allergen Immunotherapy

Hollstein

Matzke

Lorbeer

et al. 2023

Int Arch Allergy Immunol

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“…Hilary H. Chan 1 | Amanda K. Burrows 1 | Giselle Hosgood 2 | Rudayna Ghubash 3 identifying the insect based on owner observation at the time of anaphylaxis and/or retrieving the stinger from the skin or haircoat, and thus can be unreliable. While neither the strength of reactions on IDT nor sIgE can predict the grade of anaphylaxis, 8 the availability of an accurate diagnostic test to support diagnosis of a Hymenoptera hypersensitivity and aid identification of the venom would be useful in a clinical setting. Venom IDT is used to support a diagnosis of Hymenoptera hypersensitivity.…”

Section: Sensitivity Of a Hymenoptera Serological Immunoglobulin (Ig)...mentioning

confidence: 99%

Sensitivity of a Hymenoptera serological immunoglobulin (Ig)E assay for the diagnosis of venom hypersensitivity in dogs

Chan

Burrows

Hosgood

et al. 2023

Veterinary Dermatology

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BackgroundHymenoptera envenomation with honey bee (Apis mellifera) and paper wasp (Polistes spp.) may cause life‐threatening anaphylaxis in dogs. In human patients, clinical history, intradermal testing (IDT) and measurement of allergen‐specific serological immunoglobulin (Ig)E (sIgE) are used to support a diagnosis of Hymenoptera venom hypersensitivity. The utility of venom allergen‐specific sIgE has not yet been evaluated for this purpose in dogs.ObjectivesThe objective of the study was to investigate the sensitivity (sn), specificity (sp) and positive predictive value (PPV) of honey bee and paper wasp serological titres using a commercially available sIgE assay [VARL (Veterinary Allergen Reference Laboratory) Liquid Gold] against clinical history for a diagnosis of Hymenoptera hypersensitivity in dogs.Materials and MethodsHoneybee and paper wasp IgE serum titres were measured in 15 client‐owned dogs with a diagnosis of Hymenoptera venom hypersensitivity based on a history of anaphylaxis, owner observation of Hymenoptera, and positive IDT to bee and/or wasp; and in 10 client‐owned dogs with no known history of anaphylaxis or Hymenoptera exposure and a negative IDT to bee and wasp.ResultsAnalysis of receiver operating characteristic (ROC) curves demonstrate that a VARL score cut‐off of one of six for honeybee yields Sn, Sp and PPV of 40%, 60% and 60%, respectively, and two of six for wasp yields Sn, Sp and PPV of 25%, 78% and 60%, respectively.Conclusions and Clinical RelevanceOwing to the poor sensitivity and PPV of sIgE assays for both bee and wasp hypersensitivity in dogs with known envenomation and anaphylaxis, the use of sIgE cannot be recommended as a tool for venom identification.

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Molecular diagnostics and inhibition of cross‐reactive carbohydrate determinants in Hymenoptera venom allergy

Jovanovic

Perić-Popadić

Djuric

et al. 2023

Clinical & Translational All

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Background The composition of venom extracts, cross‐reactive carbohydrate determinants (CCD) and the component‐resolved diagnostics (CRD) are important fields of investigation. IgE‐reactivity to CCD complicates the interpretation of IgE to Hymenoptera venoms, especially in patients with multiple‐positivity. We analyzed the clinical importance of CRD and CCD‐inhibition for selection of allergens for venom immunotherapy (VIT). Methods In 71 patients, we measured specific IgE (sIgE) to honeybee venom (HBV), wasp venom (WV), hornet venom (HV), CCD, and recombinant allergens: phospholipase A2 (rApi m 1), hyaluronidase (rApi m 2), icarapin (rApi m 10), antigen 5 (rVes v 5), and phospholipase A1 (Immunoblot). In 29/71 HBV/WV/HV/CCD‐positive patients CCD‐inhibition was performed. According to CRD and CCD‐inhibition, we identified true sensitization and defined groups of multiple‐positive patients who needed CCD‐inhibition before starting VIT. Results sIgE‐rApi m 1, sIgE‐rApi m 2, and sIgE‐rApi m 10 were detected in 65.7%, 68.4%, and 58%, respectively. In HBV allergic patients, CRD sensitivity was 86.8%. In WV allergic patients, sensitivity of sIgE‐rVes v 5 was 94%. True multiple‐sensitization was found in 44.8% of HBV/WV/HV/CCD‐positive patients after CCD‐inhibition. Patients with multiple venom‐ and CCD‐positivity had more frequent severe allergic reactions (p < 0.001). CCD‐inhibition was helpful in HBV/WV/HV/CCD‐positive patients who were negative to all tested recombinant honeybee allergens. Persistence of HBV‐positivity after CCD‐inhibition requires CRD to other honeybee recombinant allergens. Conclusion CRD, using a profile of five most important recombinant allergens and CCD, has a high sensitivity for the diagnosis of venom allergy, especially in patients positive to several venom extracts. CRD and CCD‐inhibition are helpful to reveal the clinically relevant, true sensitization and improve the selection of venoms for long‐lasting VIT.

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Intracutaneous Skin Tests and Serum IgE Levels Cannot Predict the Grade of Anaphylaxis in Patients with Insect Venom Allergies

Cited by 7 publications

References 51 publications

Skin Tests versus Serology: Specific IgE May Suffice for Diagnosis of Vespid Venom Allergy and Follow-Up of Allergen Immunotherapy

Skin Tests versus Serology: Specific IgE May Suffice for Diagnosis of Vespid Venom Allergy and Follow-Up of Allergen Immunotherapy

Sensitivity of a Hymenoptera serological immunoglobulin (Ig)E assay for the diagnosis of venom hypersensitivity in dogs

Molecular diagnostics and inhibition of cross‐reactive carbohydrate determinants in Hymenoptera venom allergy

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