Recombinant allergen-based IgE testing to distinguish bee and wasp allergy

Mittermann, Irene; Zidarn, Mihaela; Šilar, Mira; Marković-Housley, Z.; Aberer, Werner; Korošec, Peter; Košnik, Mitja; Valenta, Rudolf

doi:10.1016/j.jaci.2010.03.017

Cited by 108 publications

(90 citation statements)

References 30 publications

(59 reference statements)

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“…The prevalence of sensitization to rApi m 2 in our population (52.6% in group A and 75% in group B) is higher than the rates of 47.9% and 52.2% described respectively by Köhler et al [4] and Sturm et al [9]. This may be due to regional differences or to the presence of sensitizing sources other than HBV, as Api m 2 has been recognized as a cross-reactivity marker between bee and wasp venoms [16]. The third allergen studied, the synthetic peptide Api m 4, was detected in 47% of patients in group A; this rate is similar to that described in a recent study [9].…”

Section: Clinical Changes Bvit Safetycontrasting

confidence: 68%

IgE-Api m 4 Is Useful for Identifying a Particular Phenotype of Bee Venom Allergy

Ruiz¹,

Serrano²,

Moreno‐Aguilar³

2016

J Investig Allergol Clin Immunol

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Background and Objective: Different clinical behaviors have been identified in patients allergic to bee venom. Compound-resolved diagnosis could be an appropriate tool for investigating these differences. The aims of this study were to analyze whether specific IgE to Api m 4 (sIgE-Api m 4) can identify a particular kind of bee venom allergy and to describe response to bee venom immunotherapy (bVIT). Methods: Prospective study of 31 patients allergic to bee venom who were assigned to phenotype group A (sIgE-Api m 4 <0.98 kU/L), treated with native aqueous (NA) extract, or phenotype group B (sIgE-Api m 4 ≥0.98 kU/L), treated with purified aqueous (PA) extract. Sex, age, cardiovascular risk, severity of preceding sting reaction, exposure to beekeeping, and immunological data (intradermal test, sIgE/ sIgG4-Apis-nApi m 1, and sIgE-rApi m 2-Api m 4 were analyzed. Systemic reactions (SRs) during bVIT build-up were analyzed. Immunological and sting challenge outcomes were evaluated in each group after 1 and 2 years of bVIT. Results: Phenotype B patients had more severe reactions (P=.049) and higher skin sensitivity (P=.011), baseline sIgE-Apis (P=.0004), sIgE-nApi m 1 (P=.0004), and sIgG4-Apis (P=.027) than phenotype A patients. Furthermore, 41% of patients in group B experienced SRs during the build-up phase with NA; the sting challenge success rate in this group was 82%. There were no significant reductions in serial intradermal test results, but an intense reduction in sIgE-nApi m 1 (P=.013) and sIgE-Api m 4 (P=.004) was observed after the first year of bVIT. Conclusion: Use of IgE-Api m 4 as the only discrimination criterion demonstrated differences in bee venom allergy. Further investigation with larger populations is necessary.

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Section: Clinical Changes Bvit Safetycontrasting

confidence: 68%

IgE-Api m 4 Is Useful for Identifying a Particular Phenotype of Bee Venom Allergy

Ruiz¹,

Serrano²,

Moreno‐Aguilar³

2016

J Investig Allergol Clin Immunol

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“…Furthermore, in Hymenoptera-allergic patients, double IgE positivity to bee and wasp venom is often evident, and thus, the identification of the culprit venom could be difficult [17,18]. Moreover, in the case of Hymenoptera-allergic patients with negative venom-specific IgE antibodies, both BAT and/or intradermal tests can show double-positive results [3], and this double positivity can hamper the identification of the relevant venom for immunotherapy, especially if the patient has an anaphylactic reaction to only one insect.…”

Section: Discussionmentioning

confidence: 99%

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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“…The patients develop IgE antibodies to this hapten that is present on all non-primate mammalian food products. This is comparable to the sensitization that occurs to inhaled plant oligosaccharides such as MUXF3--a hapten on the glycoproteins of many plant species [31][32][33] . Unlike alpha-gal, IgE antibodies to these plantderived cross-reactive carbohydrate determinants (CCD) have not been shown to contribute to symptoms related to pollen exposure 31,34 .…”

Section: Mechanisms Of Anaphylaxismentioning

confidence: 73%

The alpha-gal story: Lessons learned from connecting the dots

2015

Journal of Allergy and Clinical Immunology

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Anaphylaxis is a severe allergic reaction that can be rapidly progressing and fatal; thus, establishing the etiology of anaphylaxis is pivotal to long-term risk management. Our recent work has identified a novel IgE antibody response to a mammalian oligosaccharide epitope, galactosealpha-1,3-galactose (alpha-gal). IgE to alpha-gal has been associated with two distinct forms of anaphylaxis: i) immediate onset anaphylaxis during first exposure to intravenous cetuximab, and ii) delayed onset anaphylaxis 3-6 hours after ingestion of mammalian food products (e.g., beef and pork). Results of our studies and those of others strongly suggest that tick bites are a cause, if not the only significant cause, of IgE antibody responses to alpha-gal in the southern, eastern and central United States, Europe, Australia and parts of Asia. Typical immune responses to carbohydrates are considered to be T cell-independent, while IgE antibody production is thought to involve sequential class-switching that requires input from T cells. Therefore, establishing the mechanism of the specific IgE antibody response to alpha-gal will be an important aspect to address as this area of research continues.

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Recombinant allergen-based IgE testing to distinguish bee and wasp allergy

Cited by 108 publications

References 30 publications

IgE-Api m 4 Is Useful for Identifying a Particular Phenotype of Bee Venom Allergy

IgE-Api m 4 Is Useful for Identifying a Particular Phenotype of Bee Venom Allergy

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

The alpha-gal story: Lessons learned from connecting the dots

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