The sting challenge test in Hymenoptera venom allergy Position paper of the subcommittee on Insect Venom Allergy of the European Academy of Allergology and Clinical Immunology

Ruëff, Franziska; Przybilla, Bernhard; Müller, Ulrich; Mosbech, H.

doi:10.1111/j.1398-9995.1996.tb04596.x

Cited by 78 publications

(84 citation statements)

References 64 publications

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“…90 This may also explain the difference in the reaction rate to sting challenges, which has also been observed in untreated patients. [104][105][106] It also appears that the broad sensitization pattern in honeybee venom-allergic patients may play a role in the lower effectiveness of honeybee VIT. 107 For example, some patients are predominantly sensitized to Api m 10, which may be underrepresented in certain available honeybee venom preparations.…”

Section: Adherencementioning

confidence: 99%

EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

Sturm

Varga

Roberts

et al. 2017

Allergy

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380

528

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Hymenoptera venom allergy is a potentially life‐threatening allergic reaction following a honeybee, vespid, or ant sting. Systemic‐allergic sting reactions have been reported in up to 7.5% of adults and up to 3.4% of children. They can be mild and restricted to the skin or moderate to severe with a risk of life‐threatening anaphylaxis. Patients should carry an emergency kit containing an adrenaline autoinjector, H1‐antihistamines, and corticosteroids depending on the severity of their previous sting reaction(s). The only treatment to prevent further systemic sting reactions is venom immunotherapy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Venom Immunotherapy as part of the EAACI Guidelines on Allergen Immunotherapy initiative. The guideline aims to provide evidence‐based recommendations for the use of venom immunotherapy, has been informed by a formal systematic review and meta‐analysis and produced using the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included representation from a range of stakeholders. Venom immunotherapy is indicated in venom‐allergic children and adults to prevent further moderate‐to‐severe systemic sting reactions. Venom immunotherapy is also recommended in adults with only generalized skin reactions as it results in significant improvements in quality of life compared to carrying an adrenaline autoinjector. This guideline aims to give practical advice on performing venom immunotherapy. Key sections cover general considerations before initiating venom immunotherapy, evidence‐based clinical recommendations, risk factors for adverse events and for relapse of systemic sting reaction, and a summary of gaps in the evidence.

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Section: Adherencementioning

confidence: 99%

EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

Sturm

Varga

Roberts

et al. 2017

Allergy

Self Cite

380

528

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show abstract

“…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. In fact, as deliberate sting challenges carry a considerably risk for anaphylaxis, the technique is not recommended as a diagnostic instrument in untreated patients (9)(10)(11). We have demonstrated venom-induced lymphocyte proliferation to have a sensitivity of 72% in wasp venom anaphylaxis (12).…”

mentioning

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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“…Although venom immunotherapy is effective in the majority of Hymenoptera venomallergic patients, systemic allergic side effects to immunotherapy injections have been observed in 20-40% of patients. According to sting challenge tests during venom immunotherapy, 10-20% of patients were not protected by venom immunotherapy and continued to develop generalized allergic symptoms (2,3). Thus, there is considerable interest in improving safety and efficacy of diagnostic approaches and Hymenoptera venom immunotherapy.…”

mentioning

confidence: 99%

Identification, Recombinant Expression, and Characterization of the 100 kDa High Molecular Weight Hymenoptera Venom Allergens Api m 5 and Ves v 3

Blank

Seismann

Bockisch

et al. 2010

The Journal of Immunology

112

107

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The sting challenge test in Hymenoptera venom allergy Position paper of the subcommittee on Insect Venom Allergy of the European Academy of Allergology and Clinical Immunology

Abstract: The following members of the subcommittee have contributed by communicating information and comments: W.

Cited by 78 publications

References 64 publications

EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy

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

Identification, Recombinant Expression, and Characterization of the 100 kDa High Molecular Weight Hymenoptera Venom Allergens Api m 5 and Ves v 3

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