Stinging insect hypersensitivity

Golden, David B.K.; Demain, Jeffrey G.; Freeman, Theodore M.; Graft, David F.; Tankersley, Michael S.; Tracy, James M.; Blessing-Moore, Joann; Bernstein, David I.; Dinakar, Chitra; Greenhawt, Matthew; Khan, David A.; Lang, David M.; Nicklas, Richard A.; Oppenheimer, John; Portnoy, Jay M.; Randolph, Christopher; Schuller, Diane E.; Wallace, Dana

doi:10.1016/j.anai.2016.10.031

Cited by 211 publications

(127 citation statements)

References 210 publications

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“…Hymenoptera stings are among the most frequent causes of severe anaphylaxis in adults in Europe [2] and account for approximately 20% of the anaphylaxis-related fatalities worldwide [3]. The prevalence of systemic reactions ranges from 0.3-7.5% in European population [4] and from 0.5-3.3% in the United States [5], while in Latin America, Hymenoptera stings elicit about 15% of the severe allergic reactions annually reported [6].…”

Section: Introductionmentioning

confidence: 99%

Current challenges in molecular diagnostics of insect venom allergy

2020

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Background Advanced component-resolved diagnostics (CRD) in Hymenoptera venom allergy (HVA) has improved the precise description of individual sensitization profiles. However, diagnostic gaps, peptidebased cross-reactivity, early identification of severe reactors and diagnosis of patients with a clear history of sting reactions but negative specific IgE and skin tests, remain challenging. Methods Systematic literature search in PubMed and critical analysis of recently published studies on insect venom allergy diagnostics. Results and discussion CRD has increased the sensitivity of IgE testing and improved the discrimination of primary sensitization from irrelevant cross-reactivity, ultimately providing a better rationale for therapeutic decisions. Despite these major advances, there is still room for improvement in routine HVA diagnostics. Peptide based cross-reactivity among homologous allergens from Vespinae and Polistinae venoms as well as still existing diagnostic gaps are particularly challenging. No marker allergens are currently available to differentiate Vespula and Polistes sensitizations. Several strategies including clinical setting of basophil activation test (BAT) for routine diagnostics, venomic analysis for the identification of novel allergens and characterization of the molecular basis of A. Perez-Riverol · T. Jakob ( )

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Section: Introductionmentioning

confidence: 99%

Current challenges in molecular diagnostics of insect venom allergy

2020

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“…Untreated children who have experienced moderate to severe index sting reactions, however, are at an increased risk of relapse compared to those with a history of urticaria or angioedema only, and the severity of recurring anaphylaxis was found to correspond to that of the initial reaction [10, 11]. Based on these observations, international guidelines state that venom immunotherapy (VIT) should be recommended for children with a history of moderate to severe sting-induced anaphylaxis, but not for those with only urticaria and/or angioedema [4, 5]. …”

Section: Introductionmentioning

confidence: 99%

Safety of 100 µg venom immunotherapy rush protocols in children compared to adults

Stoevesandt

Hosp

Kerstan

et al. 2017

Allergy Asthma Clin Immunol

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BackgroundThere is a paucity of studies examining the safety of venom immunotherapy (VIT) in children. We aimed to assess the incidence of anaphylactic side effects during rush VIT in a cohort of pediatric patients and adult controls.Methods72 consecutive cycles of VIT-buildup in 71 children/adolescents aged 7–17 years were retrospectively evaluated and compared to an adult control group (n = 981) with regard to baseline parameters (sex, causative venom, severity of index sting reaction, results of allergy testing, comorbidities) and the incidence of anaphylactic adverse reactions.ResultsCompared to adults, severe index sting-induced anaphylaxis was significantly less common in children (P = .001). Children were more likely to suffer from bee venom allergy (P < .001) and showed higher levels of bee venom-specific IgE (P = .013), but lower serum tryptase concentrations (P = .014). The overall rate of VIT-induced anaphylactic reactions was higher in children than in adults (6.9% vs 2.5%, P = .046 by univariate analysis). In the final binary logistic regression model, however, only bee VIT (P = .039; odds ratio 2.25; confidence interval 1.04–4.87) and 5-day compared to 3-day buildup protocols (P = .011; odds ratio 2.64; confidence interval 1.25–5.57) were associated with an increased risk of treatment-induced anaphylaxis. All pediatric patients finally reached and tolerated the target maintenance dose of 100 µg.ConclusionsThe higher anaphylactic reaction rate observed in pediatric patients may be attributed to a greater prevalence of bee venom allergy. VIT-induced anaphylaxis in children is usually mild and does not affect further updosing and maintenance of VIT.

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“…Stoevesandt et al [15] concluded that cardiovascular medications, including BB and ACE-i, did not impair the safety of VIT, but most of their patients received wasp VIT and BB treatment was stopped during build-up unless considered necessary. Disregarding the controversy, it is still recommended to stop BB and ACE-i treatment before VIT if feasible [4]. …”

Section: Discussionmentioning

confidence: 99%

“…These risk factors include concomitant cardiovascular disease (CVD), high baseline serum tryptase levels, bee venom (BV) allergy, antihypertension medication including β-blockers (BB) and angiotensin-converting enzyme inhibitors (ACE-i), severe uncontrolled asthma, and age <5 or >70 years. Autoimmune disease and malignancy are considered risk factors by some authors, especially due to the risk of exacerbation of these diseases [2,3,4,5,6]. Several studies have also suggested that accelerated build-up protocols (rush VIT; RVIT) are also associated with a higher risk of VIT-ISR [2,6].…”

Section: Introductionmentioning

confidence: 99%

Venom Immunotherapy in High-Risk Patients: The Advantage of the Rush Build-Up Protocol

Rosman

Confino‐Cohen²,

Goldberg³

2017

Int Arch Allergy Immunol

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Background: Venom immunotherapy (VIT) is considered to be the gold standard treatment for patients with hymenoptera venom allergy. This treatment induces systemic reactions (SR) in a significant number of patients. Objective: To evaluate the outcome of VIT in patients with known risk factors for VIT-induced SR and to compare rush VIT (RVIT) and conventional VIT (CVIT). Methods: All of the patients who received VIT and had at least one of the following risk factors were included: current cardiovascular disease, uncontrolled asthma, high basal serum tryptase, current treatment with β-blockers or angiotensin-converting enzyme inhibitors, and age >70 or <5 years. Results: Sixty-four patients were included, and most of them (52; 81.5%) were allergic exclusively to bee venom. Thirty-five (54.7%) patients underwent RVIT and 29 CVIT. The incidence of patients who developed SR during the build-up phase was similar for RVIT and CVIT (25.7 and 27.5%, respectively; p = 1). However, the incidence of SR per injection was significantly higher in CVIT than in RVIT (5.6 and 2.75%, respectively; p = 0.01). Most reactions (79.1%) were mild, limited to the skin. Most of the patients (92.1%) reached the full maintenance dose of 100 μg. This dose was reached by a significantly larger number of patients receiving RVIT compared to CVIT (100 and 82.7%, respectively; p = 0.01). None of the patients experienced exacerbation of their concurrent chronic disease during VIT. Conclusion: VIT can be performed safely and efficiently in patients with risk factors for immunotherapy. In these patients RVIT appears to be safer and more efficient than CVIT.

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Stinging insect hypersensitivity

Cited by 211 publications

References 210 publications

Current challenges in molecular diagnostics of insect venom allergy

Current challenges in molecular diagnostics of insect venom allergy

Safety of 100 µg venom immunotherapy rush protocols in children compared to adults

Venom Immunotherapy in High-Risk Patients: The Advantage of the Rush Build-Up Protocol

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