The frequency and clinical significance of specific IgE to both wasp (<i>Vespula</i>) and honey‐bee (<i>Apis</i>) venoms in the same patient

Egner, William; Ward, Christopher; Brown, D L; Ewan, P. W.

doi:10.1046/j.1365-2222.1998.00176.x

Cited by 43 publications

(45 citation statements)

References 35 publications

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“…In Hymenoptera allergy, cross-reactions due to cross-reactive carbohydrate determinants (CCDs) causing double-positive test results for honeybee and wasp venom have been frequently reported [6, 7]. In cases of double sensitization, a method-based problem also has to be considered; the frequency of double-positive test results ranges between 10% (Phadebas RAST) and 30% (CAP), depending on the test method used [8]. Some of the detected sensitizations might be explained by nonspecific in vitro cross-reactivity; during the IgE assay, serum IgE antibodies are free and can easily bind to all available epitopes.…”

Section: Introductionmentioning

confidence: 99%

Asymptomatic Sensitization to Hymenoptera Venom Is Related to Total Immunoglobulin E Levels

Sturm¹,

Schuster²,

Kranzelbinder³

et al. 2008

Int Arch Allergy Immunol

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Background: The detection of specific serum immunoglobulin E (sIgE) to Hymenoptera venoms is an established diagnostic tool to diagnose insect venom hypersensitivity. However, the specificity of sIgE detection is a debated issue. Methods: In 145 subjects, total IgE (tIgE) and sIgE to Hymenoptera venoms as well as sIgE to rapeseed as a marker of cross-reactive carbohydrate determinants were measured. In addition, an atopy score was determined for each patient. We looked for a possible association between tIgE and the presence of sIgE in subjects with a negative history of large local or systemic reactions to insect stings. Results: Fifteen of 65 subjects (23.1%) with low levels of tIgE (<50 kU/l) had sIgE for bee or wasp venom, and 23 of 47 subjects (48.9%) with a tIgE from 50 to 250 kU/l showed sIgE. The highest rate of asymptomatic sensitization (22 of 33; 66.7%) was found in patients with tIgE levels higher than 250 kU/l. Median sIgE was approximately 4.8 times higher in subjects with tIgE levels above 250 kU/l than in those with tIgE levels <50 kU/l. Interestingly, a significant difference in median tIgE was recorded between individuals with and without sIgE to rapeseed [776.5 kU/l (25, 75% percentiles: 252.5, 2,000.0) vs. 50.5 kU/l (20.1, 172.0), respectively; p < 0001]. Conclusion: Specific antibodies are frequently seen in individuals with high tIgE, but appear to be largely irrelevant in clinical terms. This might lead to misdiagnosis in persons with an inconclusive sting history.

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Section: Introductionmentioning

confidence: 99%

Asymptomatic Sensitization to Hymenoptera Venom Is Related to Total Immunoglobulin E Levels

Sturm¹,

Schuster²,

Kranzelbinder³

et al. 2008

Int Arch Allergy Immunol

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“…In addition to clinical history, skin test results and IgE determination are also helpful for the selection of the appropriate venom for the immunotherapy [2]. About 30% of the hymenoptera-allergic patients show double sensitization to the honeybee and wasp in Pharmacia CAP [3]. Some of these patients, particularly those who were stung by just one insect, have a primary sensitization to only one insect venom with IgE antibodies reacting with similar epitopes in the other venom.…”

Section: Introductionmentioning

confidence: 99%

Double Sensitization to Honeybee and Wasp Venom: Immunotherapy with One or with Both Venoms?

Straumann

Bucher

Wüthrich

2000

Int Arch Allergy Immunol

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Background: Double sensitization to honeybee (Apis mellifera) and wasp venom (Vespula spp.) as determined by skin test and measurement of specific IgE is common in hymenoptera sting allergy. Double-sensitized patients have either distinct antibodies for each venom or cross-reacting antibodies that recognize similar or identical epitopes in both venoms. Unfortunately, patients often fail to identify the stinging insect which makes it difficult to distinguish cross-reactors from non cross-reactors. However, for economic reasons as well as for the benefit of the patients, it would be useful to identify complete cross-reactors. Methods: In this study we investigated 24 double-sensitized patients who were candidates for venom immunotherapy. Homologous and heterologous FEIA inhibition was carried out with honeybee (Apis mellifera) and wasp venom (Vespula spp.) preparations from two different providers. The inhibitor concentrations were ranging from 0 to 100 μg protein/ml. Results: Sera of 4 patients were completely cross-reacting for one venom (3 honeybee, 1 wasp), 8 patients were partially cross-reacting and 10 patients were not cross-reacting. Two patients were excluded from the study due to insufficient homologous inhibition. Data from specific IgE measurements, skin test, and clinical history were not useful for the identification of cross-reacting patients. Conclusion: FEIA inhibition is easy to perform and useful for the identification of patients with complete cross-reactivity. In these patients immunotherapy might be restricted to one venom which is beneficial for the patient and cost-effective.

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“…Currently, diagnosis of venom anaphylaxis generally relies upon an evocative history corroborated by positive venom skin tests (VST) and venom-specific IgE. Although each method can provide useful information, both have in se limitations (1)(2)(3)(4)(5)(6)(7). Sting challenge tests have been thoroughly described (8), but several practical and mainly ethical issues, as well as the observation that a single negative sting challenge does not definitely indicate absence of hypersensitivity certainly limits its application.…”

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confidence: 99%

Flow‐assisted quantification of in vitro activated basophils in the diagnosis of wasp venom allergy and follow‐up of wasp venom immunotherapy

Ebo

Hagendorens

Schuerwegh

et al. 2006

Cytometry Part B Clinical

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Background: Correct identification of the culprit venom is a prerequisite for specific venom immunotherapy (VIT). Despite the efficacy of VIT, issues as how to monitor treatment and when to discontinue maintenance therapy remain to be established.Methods: To evaluate diagnostic performances of the basophil activation test (BAT) in wasp venom allergy, 80 patients with a definite history of wasp venom anaphylaxis (systemic reactors) and 14 waspstung asymptomatic controls (stung controls) were enrolled. Venom-induced basophil activation was analyzed flow cytometrically by double-labeling with anti-IgE and anti-CD63. Results were compared to wasp IgE levels and results of a venom skin test (VST). To establish whether the BAT constitutes a candidate marker to monitor VIT, the BAT was repeated in 22 patients on the 5th day of a build-up course and after 6 months of maintenance VIT. Whether the BAT could contribute in the decision of discontinuing VIT was assessed in a cross-sectional analysis in 30 patients receiving treatment for 3 years.Results: Comparison between systemic reactors and stung controls revealed a sensitivity of 86.4% and specificity of 100% for venom IgE, and sensitivity of 81.8% for VST, respectively. In contrast to stung controls, patients demonstrated dose-dependent venom-induced basophil activation. The BAT attained a sensitivity of 83.8% and specificity of 100%. At the end of the build-up course, no effect of VIT on the BAT was demonstrable. When the BAT was repeated after 6 months of treatment, submaximal stimulation of the cells demonstrated a significant decreased CD63 expression (P < 0.04). Patients having VIT for 3 years also demonstrated significantly lower venom-induced CD63 expression (P < 0.001). After 3 years, 60% of the patients had a negative BAT for submaximal stimulation of the cells whereas only 17.9% of the patients had negativation of wasp IgE.Conclusions: The BAT is a reliable instrument for the diagnosis of wasp venom anaphylaxis and might constitute an instrument to monitor wasp VIT. q

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The frequency and clinical significance of specific IgE to both wasp (Vespula) and honey‐bee (Apis) venoms in the same patient

Abstract: If used in isolation CAP may be misleading, especially if only one venom is tested. Identification of the causative venom must utilize both clinical history and skin testing in these double-positive patients, and challenge testing if indicated.

Cited by 43 publications

References 35 publications

Asymptomatic Sensitization to Hymenoptera Venom Is Related to Total Immunoglobulin E Levels

Asymptomatic Sensitization to Hymenoptera Venom Is Related to Total Immunoglobulin E Levels

Double Sensitization to Honeybee and Wasp Venom: Immunotherapy with One or with Both Venoms?

Flow‐assisted quantification of in vitro activated basophils in the diagnosis of wasp venom allergy and follow‐up of wasp venom immunotherapy

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