The evaluation of the common diagnostic methods of hypersensitivity for bee and yellow jacket venom by means of an in-hospital insect sting

Blaauw, P.J.; Smithuis, L. O. M. J.

doi:10.1016/0091-6749(85)90029-6

Cited by 122 publications

(73 citation statements)

References 17 publications

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“…On the other hand, many patients with low or even undetectable venom IgG were protected. Thus the absolute level of venom IgG may not be the "gold standard" for the prediction of efficacy of VIT nor for the selection of at risk patients (6). The increase of venom specific IgG expressed as the ratio of levels before and after 3 or 6 months of VIT may actually be a better predictive test.…”

Section: Prediction Of the Efficacy Of Immunotherapymentioning

confidence: 99%

Section: Prediction Of the Efficacy Of Immunotherapymentioning

confidence: 99%

“…The amount of venom delivered by one sting seems fairly constant in the honey bee, where the sting is left in the skin (6,34). It varies considerably, however, in vespids and may explain the more frequent negative sting challenges in vespid allergic patients (6,34). When a patient has presented no reaction after a sting challenge, this does not necessarily mean that he is definitely protected since resensitizations during VIT have been described (46), although others (6,63) observed no systemic reactions in a limited number of patients during repeated sting challenge.…”

Section: Prediction Of the Efficacy Of Immunotherapymentioning

confidence: 99%

“…According to prospective studies (Table 1) 20-84% of patients who have experienced systemic anaphylactic symptoms and demonstrate venom specific IgE do not have another systemic reaction when restung by the same insect species. It appears that the rate Table 1 Prospective studies on the natural history of Hymenoptera sting allergy of spontaneous hyposensitization is higher in mild than in severe systemic reactions (6,29,37,47,58,63,69,70,75,76) in children than in adults (see Table 1), and in vespid than in honey bee sting allergy (6), Some authors claim that the IgG/IgE ratio may help to define high risk patients (81,85), The diagnosis of allergy to venoms is based on a suggestive history of anaphylaxis, positive skin tests to venoms, or the presence of serum venom specific IgE, Wiithrich et al (49,89) proposed adding basophil degranulation tests to this panel, since this was shown to enhance the diagnosis in difficult cases. The diagnostic criteria differ according to investigators.…”

Section: Selection Of Patients Requiring Venom Immunotherapymentioning

confidence: 99%

“…The most reliable test to judge the efficacy of VIT is the provocative sting challenge with a live insect (6,63); this must be done in an intensive care unit. The amount of venom delivered by one sting seems fairly constant in the honey bee, where the sting is left in the skin (6,34).…”

Section: Prediction Of the Efficacy Of Immunotherapymentioning

confidence: 99%

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Immunotherapy with Hymenoptera venoms

Bousquet¹,

Müller

Dreborg

et al. 1987

Allergy

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Immunotherapy with Hymenoptera venoms is widely used throughout the world and is accepted as an effective treatment for most patients with Hymenoptera venom allergy. There are, however, still some unresolved problems with this form of treatment. At present there is no definite test which makes it possible to identify patients at risk ‐ and thus candidates for immunotherapy ‐ unequivocally. On the basis of prospective studies on the natural history of Hymenoptera allergy, venom immunotherapy is indicated in adults with severe systemic anaphylaxis. It is usually not necessary in patients with large local reactions only. Children with mild systemic reactions, e.g. urticaria, will need immunotherapy only in case of repeated reactions and/or a high risk of re‐exposure. The selection of venoms for immunotherapy may lead to some confusion owing to common antigenic determinants shared by venoms of various Hymenoptera species. Many different regimens for immunotherapy have been proposed. At present, the three main are: rush, stepwise or clustered and classical. The maintenance dose of 100 μg usually protects from life‐threatening reactions. However, in some patients 200 μg are necessary for complete protection. The usual interval between maintenance injections is 4 to 6 weeks. In many patients a strong increase of venom specific serum IgG‐antibodies usually parallels clinical protection induced by venom immunotherapy, although many exceptions have been reported. Allergic side effects of venom immunotherapy are not rare, especially with honey bee venom and during the initial phase of dose increase. The question of the duration of venom immunotherapy is handled differently: although some authors recommend treatment for life, most suggest treating patients until skin tests and RAST become negative.

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Section: Prediction Of the Efficacy Of Immunotherapymentioning

confidence: 99%

Section: Prediction Of the Efficacy Of Immunotherapymentioning

confidence: 99%

Section: Prediction Of the Efficacy Of Immunotherapymentioning

confidence: 99%

Section: Selection Of Patients Requiring Venom Immunotherapymentioning

confidence: 99%

Section: Prediction Of the Efficacy Of Immunotherapymentioning

confidence: 99%

See 3 more Smart Citations

Immunotherapy with Hymenoptera venoms

Bousquet¹,

Müller

Dreborg

et al. 1987

Allergy

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Interleukin-10 levels increase in cutaneous biopsies of patients undergoing wasp venom immunotherapy

et al. 2001

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We have studied the influence of wasp venom immunotherapy (VIT) on cellular recruitment and cytokine mRNA expression during allergen‐induced cutaneous late‐phase responses (LPR). Nine subjectswith a history of wasp sting anaphylaxis, and specific IgE in their sera underwent wasp VIT. Skin biopsies were taken 24 h after intradermal diluent and allergen before and after 3 months VIT. Pre‐immunotherapy, there were significant allergen‐induced increases in EG2+ eosinophils, elastase+ neutrophils, CD68+ macrophages and IL–10 protein+ cells, and increased expression of mRNA for IL–4, IL–13, IFN–γ, IL–12, IL–10, TGF‐β, RANTES and eotaxin. When these allergen‐induced changes in cytokine mRNA and cellular profiles were compared with those obtained after 3 months VIT there was a significant reduction in IL–4 mRNA (p=0.012) and increase in IL–10 protein+ cells (p=0.004) with a trend to an increase in IL–10 mRNA (p=0.054). There were also significant reductions in eosinophils (p<0.004) and the size of the cutaneous LPR (p<0.01) but no change in mRNA to IFN–γ, IL–13 or IL–12. Therefore, VIT is associated with a significant increase in cells positive for IL–10 protein but not IL–12 or IFN–γ. These results suggest that induction of IL–10 may be important in VIT and occur independently of the switch to a Th1 phenotype. IL–10 generation may down‐regulate IL–4 expression and eosinophil recruitment.

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Duration of Venom Immunotherapy

Golden

2017

Stinging Insect Allergy

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The evaluation of the common diagnostic methods of hypersensitivity for bee and yellow jacket venom by means of an in-hospital insect sting

Cited by 122 publications

References 17 publications

Immunotherapy with Hymenoptera venoms

Immunotherapy with Hymenoptera venoms

Interleukin-10 levels increase in cutaneous biopsies of patients undergoing wasp venom immunotherapy

Duration of Venom Immunotherapy

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