Management of Double Sensitization to Vespids in Europe

Abstract

Wasp allergy with a diagnostic profile of double sensitizations to vespid venom is a frequent clinical problem in areas where different genera of wasps are present. Identification of the insect responsible for serious reactions poses a diagnostic challenge as the only effective treatment to date is immunotherapy based on the specific venom. In southern Europe, the double sensitization to Vespula and Polistes venoms is highly frequent. It has been shown that the major allergenic proteins (Phospholipase A1 and Antigen 5) share sequences across the different genera and species, which would be the cause of cross-reactivity. Additionally, the minor allergens (Dipeptidyl-peptidases, Vitellogenins) have been found to share partial sequence identity. Furthermore, venom contains other homologous proteins whose allergenic nature still remains to be clarified. The traditional diagnostic tools available are insufficient to discriminate between allergy to Vespula and Polistes in a high number of cases. IgE inhibition is the technique that best identifies the cross-reactivity. When a double sensitization has indeed been shown to exist or great uncertainty surrounds the primary sensitization, therapy with two venoms is advisable to guarantee the safety of the patient. In this case, a strategy involving alternate administration that combines effectiveness with efficiency is possible.

Hypersensitivity to Vespa velutina nigrithorax: an emerging problem in Portugal?

“…Levels of sIgE to VVN were low, according to other studies, and not directly related to reaction severity (4,6). Also in those studies, sIgE to VVN tended to be lower than Vesp v 5, which also occurred in our study, with its equivalent Ves v 5 (8).…”

“…As well as in other studies, patients more prone to hymenoptera stings and, therefore, more prone to allergic reactions, are the ones with outdoor jobs/hobbies (4,6,8).…”

“…However, in the context of research, two main allergens have been described: Vesp v 5 corresponding to antigen 5, with a homology of more than 75% with antigen 5 of Vespula spp and Polistes dominula; and Vesp v 1 corresponding to A1-phospholipase, with a homology of about 70% with A1-phospholipase of Vespula spp and Polistes dominula and in less degree with Apis mellifera. These findings suggest cross-reactivity of VVN with the most common vespids (2,4,(6)(7)(8)(9). And in fact, the majority of patients had, to some extent, sensitization to Vespula spp or Polistes dominula whole venoms (100% of patients) or their recombinants rVes v 1, rVes v 5 and rPol d 5 (n=6; 85.7%).…”

“…VVN anaphylactic reactions are increasing in the southern regions of Portugal. With the introduction of VVN extracts, the patients' diagnosis and treatment will be increasingly targeted and specific (4,(6)(7)(8).…”

Hymenoptera Allergy Diagnosis through Their Presence on Human Food

“…The correct identification of the stinging insect is a key point in the diagnosis of Hymenoptera-allergic patients in order to choose the right venom immunotherapy [ 12 , 13 ]. Adults are poor discriminators in distinguishing stinging insects and nests, with the exception of the honeybee.…”