Triple IgE-positivity to hornet, wasp and bee venom in the patient with anaphylaxis: Diagnostic and therapeutic approach

Jovanovic, Dragana; Perić-Popadić, Aleksandra; Andrejević, Sladjana; Jovanović, Igor; Bonaci-Nikolic, Branka

doi:10.2298/vsp160831144j

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…2 Multiple-positivity could be avoided by measuring CCD-sIgE. 19,20 Our results showed that determination of sIgE to recombinant major allergens is especially useful for the patients, with multiple-positivity to venom extracts and those who could not identify the insect.…”

Section: Discussionmentioning

confidence: 86%

The Diagnostic Importance of Recombinant Allergen IgE Testing in Patients with Hymenoptera Venom Allergy: Comparison of Two Methods

Jovanovic¹,

Perić-Popadić²,

Andrejević³

et al. 2021

IJAAI

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Adults with systemic anaphylactic reactions (SAR) to insect sting show often multiple-positivity of serum-specific IgE (sIgE) to Hymenoptera venoms. Unnecessary long-lasting venom-specific immunotherapies (VIT) in false-positive patients increase the risk of recurrent SAR. This report aims to analyze the diagnostic importance of recombinant allergen IgE testing in patients with SAR to Hymenoptera sting.In 82 patients we measured sIgE to honeybee venom (HBV), wasp venom (WV) and hornet venom (HV) extracts, recombinant phospholipase A2 from HBV (sIgE-rApi m1), recombinant antigen 5 from WV (sIgE-rVes v5), and cross-reactive carbohydrate determinants-CCD-bromelain by ImmunoCAP. We analyzed the correlation of ImmunoCAP and Immunoblot for HBV and WV extracts, rApi m1, and rVes v5 in 39/82 patients. According to the history of the culprit insect, we compared sensitivity and specificity between the two methods.The severity of the SAR does not depend on the sIgE level to venom extracts and recombinant allergens. Fifty-one percent of the patients had a multiple-positivity to HBV/WV or HBV/WV/HV extracts. Severe SAR and CCD-sIgE were more frequent in multiple-positive than single-positive patients. CCD-sIgE were more frequent in HBV allergic patients than WV and HV allergic patients. There was a significant correlation between levels of sIgE to venom extracts and recombinant allergens measured by ImmunoCAP and Immunoblot. ImmunoCAP has higher sensitivity and specificity than Immunoblot for diagnosis of SAR to Hymenoptera venoms.IgE testing to recombinant CCD-free allergens is necessary for the adequate selection of long-lasting VIT, especially in patients with multiple sensitivities to venom extracts.

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Section: Discussionmentioning

confidence: 86%

The Diagnostic Importance of Recombinant Allergen IgE Testing in Patients with Hymenoptera Venom Allergy: Comparison of Two Methods

Jovanovic¹,

Perić-Popadić²,

Andrejević³

et al. 2021

IJAAI

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“…28 However, skin-testing may show rVes v 5 should be based on CRD, severity of SAR and history of insect sting allergy. 27,30,31 Interestingly, the sensitivity of HBV-single-positivity was significantly increased after CCD-inhibition from 0% to 77% in our third group of HBV/WV/HV/CCD-positive honeybee allergic patients. In this group of patients CCD-inhibition can replace expensive CRD.…”

Section: Discussionmentioning

confidence: 54%

“…Although, Api m 2 shows a high percentage of homology with Ves v 2, 27,29 it can sometimes be difficult to determine whether these results reflect sensitization due to cross‐reactivity between the shared protein determinants or true double sensitization to both insect species. Since HBV‐allergic patients can have Api m 2 mono‐sensitization, a decision regarding VIT in patients with IgE‐reactivity to rApi m 2 and rVes v 5 should be based on CRD, severity of SAR and history of insect sting allergy 27,30,31 …”

Section: Discussionmentioning

confidence: 99%

Molecular diagnostics and inhibition of cross‐reactive carbohydrate determinants in Hymenoptera venom allergy

Jovanovic

Perić-Popadić

Djuric

et al. 2023

Clinical & Translational All

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Background The composition of venom extracts, cross‐reactive carbohydrate determinants (CCD) and the component‐resolved diagnostics (CRD) are important fields of investigation. IgE‐reactivity to CCD complicates the interpretation of IgE to Hymenoptera venoms, especially in patients with multiple‐positivity. We analyzed the clinical importance of CRD and CCD‐inhibition for selection of allergens for venom immunotherapy (VIT). Methods In 71 patients, we measured specific IgE (sIgE) to honeybee venom (HBV), wasp venom (WV), hornet venom (HV), CCD, and recombinant allergens: phospholipase A2 (rApi m 1), hyaluronidase (rApi m 2), icarapin (rApi m 10), antigen 5 (rVes v 5), and phospholipase A1 (Immunoblot). In 29/71 HBV/WV/HV/CCD‐positive patients CCD‐inhibition was performed. According to CRD and CCD‐inhibition, we identified true sensitization and defined groups of multiple‐positive patients who needed CCD‐inhibition before starting VIT. Results sIgE‐rApi m 1, sIgE‐rApi m 2, and sIgE‐rApi m 10 were detected in 65.7%, 68.4%, and 58%, respectively. In HBV allergic patients, CRD sensitivity was 86.8%. In WV allergic patients, sensitivity of sIgE‐rVes v 5 was 94%. True multiple‐sensitization was found in 44.8% of HBV/WV/HV/CCD‐positive patients after CCD‐inhibition. Patients with multiple venom‐ and CCD‐positivity had more frequent severe allergic reactions (p < 0.001). CCD‐inhibition was helpful in HBV/WV/HV/CCD‐positive patients who were negative to all tested recombinant honeybee allergens. Persistence of HBV‐positivity after CCD‐inhibition requires CRD to other honeybee recombinant allergens. Conclusion CRD, using a profile of five most important recombinant allergens and CCD, has a high sensitivity for the diagnosis of venom allergy, especially in patients positive to several venom extracts. CRD and CCD‐inhibition are helpful to reveal the clinically relevant, true sensitization and improve the selection of venoms for long‐lasting VIT.

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Immunotherapy in patients with the first type of hypersensitivity to Hymenoptera venoms

Jovanović¹,

Perić-Popadić²

2023

Medicinski podmladak

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Hymenoptera venom allergy (HVA) is an anaphylactic reaction that occurs after the sting of Hymenoptera insects: honeybee (Apis mellifera), wasp (Vespula vulgaris) or hornet (Vespa crabo). Hymenoptera insects can cause IgE-mediated hypersensitivity reactions in insect-sensitized patients, ranging from local to severe systemic reactions and even fatal anaphylaxis. Systemic allergic reactions (SAR) after Hymenoptera insect stings have been reported in up to 7.5% of adults and up to 3.4% of children. They can be limited to the skin or cause severe reactions such as dizziness, dyspnea, nausea, and loss of consciousness, shock, cardiac or respiratory arrest. Patients with HVA are advised to carry an emergency kit consisting of an epinephrine auto-injector (AAI), H1-antihistamines and corticosteroids depending on the severity of the previous SAR. The only treatment that can potentially prevent SAR is immunotherapy with the appropriate venom (VIT). Venom immunotherapy (VIT) has been reported to be effective in 77%-84% of patients treated with bee venom and in 91%-96% of patients treated with wasp venom. The latest European Academy of Allergy and Clinical Immunology (EAACI) guidelines provide evidence-based recommendations for the use of VIT. It is recommended in children and adults who are hypersensitive to the venom because it leads to a significant improvement in quality of life-compared to wearing an adrenaline auto-injector. By receiving increasing doses of venom over 3 to 5 years, VIT leads to a change in the immune response and tolerance to the respective venom. Molecular diagnostics, which uses recombinant allergens, enables detection of true sensitization and thus improves the selection of appropriate venom for long-term VIT. This review aims to provide information on immunotherapy recommendations, as well as risk factors for SAR during and after VIT.

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Triple IgE-positivity to hornet, wasp and bee venom in the patient with anaphylaxis: Diagnostic and therapeutic approach

Cited by 3 publications

References 17 publications

The Diagnostic Importance of Recombinant Allergen IgE Testing in Patients with Hymenoptera Venom Allergy: Comparison of Two Methods

The Diagnostic Importance of Recombinant Allergen IgE Testing in Patients with Hymenoptera Venom Allergy: Comparison of Two Methods

Molecular diagnostics and inhibition of cross‐reactive carbohydrate determinants in Hymenoptera venom allergy

Immunotherapy in patients with the first type of hypersensitivity to Hymenoptera venoms

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