Serological investigations in hymenoptera sting allergy: IgE and haemagglutinating antibodies against bee venom in patients with bee sting allergy, bee keepers and non-allergic blood donors

Specific IgE-antibodies and haemagglutinins to bee venom were determined in fifty-five bee sting allergic patients, fifty-seven bee keepers and fifty-two blood donors without evident allergy to hymenoptera stings. IgE-antibodies were detected by RAST in 70% of allergic patients, 40% of bee keepers and 12% of blood donors. Most bee keepers with detectable IgE-antibodies to bee venom recorded severe local or even general reactions to bee stings. Most blood donors with detectable specific IgE had been stung by hymenoptera in the past. High titres of haemagglutinating antibodies against phospholipase A were found in most bee keepers, occasionally in bee sting allergic patients but only rarely in blood donors. The determination of specific IgE-antibodies to insect venoms by RAST seems to be a valuable method for the diagnosis of hymenoptera sting allergy.     

Insect sting allergy and venom immunotherapy: a model and a mystery

Whole-body extracts of Hymenoptera were used for diagnosis and treatment until controlled clinical trials proved them no better than placebo, whereas venom is 85% to 98% effective. Studies of natural history reveal why whole-body extracts were thought to work. The chance of future systemic reactions is low in large local reactors and in most children and varies between 20% and 70% in adults. Venom skin tests are most accurate, but RAST is an important complementary test. The degree of sensitivity on skin tests or RASTs does not reliably predict the severity of a sting reaction. Venom immunotherapy is recommended for patients at high risk for sting reactions. Rapid regimens are as safe as slower regimens. The recommended dose is 100 microg, but some patients require higher doses for full protection. Venom immunotherapy is continued every 4 to 8 weeks for at least 5 years in most cases. Skin test results become negative in only 25% after 5 years of therapy but in 60% to 70% after 7 to 10 years. When treatment is stopped after 5 years or more, there is a 10% chance of systemic reaction to each future sting, but most reactions are mild. Some patients have a higher risk of relapse and should continue treatment for an extended period.     

Evaluation of bee sting allergy by skin tests and serum antibody assays.

We studied 55 subjects who had had anaphylactic reactions to bee stings within the previous 3 years. 38 out of 54 tested had IgE antibody to honey bee venom (HBV) as measured by radioallergosorbent test (RAST). On skin testing, 30 out of 34 had a positive test to HBV. Of these, 26 had a positive RAST. A positive skin test to HBV at high dilution or else a high anti-HBV RAST score appeared to identify those who, in a 6-month follow-up period, were at risk of developing further anaphylaxis following bee stings or immunotherapy. Of the two tests, RAST appeared to be the less sensitive. Measurements of IgG antibody to phospholipase A were seldom available for the period immediately preceding an anaphylactic episode and proved to be a poor means of predicting the liability to bee sting anaphylaxis in subsequent months.     

Antibodies to purified bee venom proteins and peptides. I. Development of a highly specific RAST for bee venom antigens and its application to bee sting allergy

IgE antibodies to purified proteins and peptides from honeybee venom have been measured by the RAST. Trace amounts (less than 0.1%) of the major venom protein phospholipase A2 (PLA2) grossly distorted the measurement of IgE antibody to the other venom proteins, acid phosphatase (Acid P) and hyaluronidase (HYAL), and overemphasized their importance. Reduction of antigen coupled to the cellulose paper discs, which were used in the assay, diluted out the contaminating PLA2 without apparent loss in sensitivity. The reduction of disc-bound antigen increased the competition between IgE and IgG antibodies but did not affect measurement of IgE antibodies in sera taken from 35 untreated patients who had a history of general allergic reactions to bee stings. In 54% of sera from bee venom--allergic patients, the greatest IgE antibody response was to PLA2. In all, IgE antibodies to PLA2 were present in 91% of these sera. IgE antibodies to Acid P, HYAL, or melittin were present in 60%, 51%, and 31% of sera, respectively, and accounted for the highest level of binding in 17%, 17%, and 6% of these. Only 6% of sera were positive for whole venom but negative for the isolated antigens. A low level of IgE antibody was found to peptide 401 in 6% of sera. No IgE antibodies were found to apamin. While confirming the central role played by PLA2 in bee sting allergy, these results show that other venom components are also important in some patients.     

Fatal anaphylactic sting reaction in a patient with mastocytosis

We report on a 33-year-old female patient with indolent systemic mastocytosis and urticaria pigmentosa who died of an anaphylactic reaction after a yellow jacket sting. As she had no history of previous anaphylactic sting reaction, there was no testing performed in order to detect hymenoptera venom sensitization. But even if a sensitization had been diagnosed, no venom immunotherapy (VIT) would have been recommended. It is almost certain that VIT would have saved her life and it is most likely that VIT is indicated in some patients with mastocytosis with no history of anaphylactic sting reaction. However, no criteria have been established in order to allow a selection of mastocytosis patients eligible for such a 'prophylactic' VIT.     

Anisakis simplex: sensitization and clinical allergy

PURPOSE OF REVIEW: Whereas gastric anisakiasis has been known for several decades, the implications of Anisakis simplex-related allergic disorders had not been thoroughly studied until the late 1990s. This article reviews recent knowledge of allergic disorders ascribed to A. simplex contact or parasitism. RECENT FINDINGS: Gastroallergic anisakiasis describes an acute hypersensitivity reaction emerging in the context of an acute parasitism by the nematode A. simplex. But other frequent allergic disorders like chronic urticaria are now being studied for a possible relationship with A. simplex parasitism. In recent investigations, non-IgE mediated mechanisms, such as the involvement of other immunoglobulin isotypes (IgG4), or non-immunological events are discussed. SUMMARY: The experience of the last several years shows that allergic hypersensitivity symptoms in gastroallergic anisakiasis are clinical events accompanying a wide range of immunologic reactions as a host response against a ubiquitous parasite. The discussed and reviewed studies should motivate allergists around the world to search for this entity. Further studies in the field of allergy could benefit from the experience of this peculiar food-related disorder.     

Rush venom immunotherapy: a 3-day programme for hymenoptera sting allergy

In a series of 102 patients consulting for allergic reactions following hymenoptera sting, fifty-two of them, who had experienced one or more severe systemic adverse reactions were selected for rush immunotherapy. The method employed made it possible to attain the maintenance dose of 100 μg of venom in 3 days. Patient tolerance was excellent, no serious side-effect was observed; immunotherapy never had to be stopped. Clinical effectiveness seems to be very satisfactory, since no abnormal reaction was reported in seven patients who later were spontaneously stung, and in fourteen patients who received an induced insect sting. The level of IgG antivenom antibodies rose regularly from the first month onwards to remain at a stable level. Because of its safety and effectiveness, it appears that this method should be recommended for immunotherapy in patients who are allergic to hymenoptera stings.     

Role of parental atopy in cow's milk allergy: a population-based study

BackgroundA family history of atopy has been considered an independent risk factor for atopic diseases in children.ObjectiveTo relate the risk of an infant developing IgE-mediated cow's milk allergy (IgE-CMA) to the atopic status of parents.MethodsAssessment of the parental atopic status of children with IgE-CMA (n = 66) previously identified in a large-scale prospective study was compared with the parental atopic status of a control group of healthy infants (n = 156). The atopic status was identified both by self-reporting and skin prick tests (SPTs).ResultsAnalysis for the risk for infants to develop IgE-CMA depended on the assessment method used. No significant differences were noted in self-reported parental atopic status between the IgE-CMA patients and the control group. However, among the subgroup of infants with persistent IgE-CMA (n = 25), maternal but not paternal self-reporting for atopy was more likely compared with parents of the control group (P = .04). In contrast, when analyzed by SPT, in both this persistent subgroup and the total allergic cohort, no significant differences were noted whether analyzed by single parent or both parents and whether the parent tested singly or multiply positive on the SPT.ConclusionIn families with children with persistent IgE-CMA, self-reporting of atopy by parents may be biased. Furthermore, the demonstration of IgE-mediated responses to allergens in parents is insufficient by itself, in a general population cohort, to predict which infants are at greatest risk of developing IgE-CMA.     

Comparison of diagnostic tests for hymenoptera sting allergy

The authors examined correlations among individual Hymenoptera venom skin tests, venom radioallergosorbent tests (RAST), venom-induced leukocyte histamine release (LHR) assays and individual Hymenoptera whole body extract (WBE) skin tests in 37 patients with histories of systemic reactions to Hymenoptera stings. Significant positive correlations were seen between the venom skin test results and results from either the venom RAST or the LHR assay for most venoms. There was a relatively high frequency of positive WBE skin tests in association with other negative tests. The ultimate diagnostic test for stinging insect sensitivity is a deliberate sting challenge; in lieu of such a sting the clinical history and the venom skin test appear to provide the best estimate of clinical Hymenoptera sting sensitivity.