The sting of the honeybee: an allergic perspective

Toxicological Risk Assessment of the Accidental Ingestion of a Honeybee (Apis mellifera L.) Present in Food

The aim of the present work was to evaluate the possible risk of toxic effects due to the ingestion of a honeybee (Apis mellifera L.) accidentally present in food. The methodology used in this study was a bibliographic survey of studies on the toxic effects related to honeybees, with a critical analysis of the possible risks of accidental ingestion of these insects. The amount of venom present in a bee is considered insufficient to induce detectable toxic effects in a person who ingests it by accident, and various components of the venom are destroyed by gastric secretions. However, despite the rare frequency, there is a risk of the ingestion of a bee, causing an allergic reaction to some components of the venom in sensitized individuals. In addition, pollen carried by a bee may cause an allergic reaction in a sensitive individual. Thus, the accidental ingestion of a bee present in a food does not pose the risk of toxic effects for the majority of the population but may promote allergic reactions in susceptible individuals.

Tissue-specific glycosylation in the honeybee: Analysis of the N-glycomes of Apis mellifera larvae and venom

BACKGROUND

Previous glycophylogenetic comparisons of dipteran and lepidopteran species revealed variations in the anionic and zwitterionic modifications of their N-glycans; therefore, we wished to explore whether species- and order-specific glycomic variations would extend to the hymenoptera, which include the honeybee Apis mellifera, an agriculturally- and allergologically-significant social species.

METHODS

In this study, we employed an off-line liquid chromatography/mass spectrometry approach, in combination with enzymatic and chemical treatments, to analyse the N-glycans of male honeybee larvae and honeybee venom in order to facilitate definition of isomeric structures.

RESULTS

The neutral larval N-glycome was dominated by oligomannosidic and paucimannosidic structures, while the neutral venom N-glycome displayed more processed hybrid and complex forms with antennal N-acetylgalactosamine, galactose and fucose residues including Lewis-like epitopes; the anionic pools from both larvae and venom contained a wide variety of glucuronylated, sulphated and phosphoethanolamine-modified N-glycans with up to three antennae. In comparison to honeybee royal jelly, there were more fucosylated and fewer Man_4/5-based hybrid glycans in the larvae and venom samples as well as contrasting antennal lengths.

CONCLUSIONS

Combining the current data on venom and larvae with that we previously published on royal jelly, a total honeybee N-glycomic repertoire of some 150 compositions can be proposed in addition to the 20 previously identified on specific venom glycoproteins.

SIGNIFICANCE

Our data are indicative of tissue-specific modification of the core and antennal regions of N-glycans in Apis mellifera and reinforce the concept that insects are capable of extensive processing to result in rather complex anionic oligosaccharide structures.

cDNA and gene structures of two phospholipase A2 isoforms, acidic PLA2 PA4 and PLA2 PA3A/PA3B/PA5, in Nemopilema nomurai jellyfish venom

We have shown that Nemopilema nomurai jellyfish venom (NnV) contains various kinds of proteolytic enzyme activities, including phospholipase (PLA), metalloproteinase (MP) and hyaluronidase activities. In this study, we reported the full-length cDNA and gene sequences of two PLA₂ isoforms: acidic PLA₂ PA4 and PLA₂ PA3A/PA3B/PA5. The full-length cDNA of acidic PLA₂ PA4 contains 483 nucleotides (nt), which encode 160 amino acids (and the stop codon), including a signal peptide, six cysteine residues that form disulfide bonds, and metal-binding and catalytic active sites. The gene sequence of the acidic PLA₂ PA4 is 1667 base pairs (bp) long and encodes three exons and two introns. The 5' donor (GT) and 3' acceptor (AG) splice sites are highly conserved. The PLA₂ PA3A/PA3B/PA5 gene contains 1366 bp, and the 498 nt of the mature mRNA encode 165 amino acids (and the stop codon). The protein includes a signal peptide, six cysteine residues that form disulfide bonds, and metal-binding and catalytic active sites. The three exons and two introns also have highly conserved donor and acceptor splice sites. InterProScan predicted PLA₂ activity domains in both isoforms. These results extend our understanding of the PLA₂ venom of the N. nomurai jellyfish and will facilitate further research.

Subcutaneous immunotherapy

BACKGROUND

Allergic rhinitis, asthma, and Hymenoptera sensitivity affect approximately 20%, 9%, and 0.66% to 3.3% of adults in the United States, respectively. Various environmental control measures and pharmacologic options are available for symptomatic treatment of allergic rhinitis and allergic asthma. However, allergen-specific immunotherapy is the only form of treatment that alters the natural history of allergic disease.

METHODS

A literature review was performed. Information from systematic reviews, meta-analyses, and practice parameters were closely examined and summarized, and they are included in this primer.

RESULTS

There is evidence that supports the use of subcutaneous immunotherapy (SCIT) for the treatment of perennial and seasonal allergic rhinitis, asthma, and Hymenoptera sensitivity. Efficacy of SCIT has been established in the adult and pediatric populations. Adverse reactions occur in up to 71% of patients. However, the rate of serious or fatal side effects is very rare.

CONCLUSION

SCIT is safe and effective in the treatment of allergic rhinitis, allergic asthma, and Hymenoptera sensitivity. Adverse reactions occur but, in general, SCIT is well tolerated, and the vast majority of reactions are mild and very rarely fatal.

Guillain-Barré syndrome following bee venom acupuncture

Bee venom acupuncture has been widely used in Oriental medicine with limited evidence of effectiveness. Most of the complications due to bee venom acupuncture are local or systemic allergic reactions. However, serious medical and neurological complications have also been reported. We herein describe the treatment of a 68-year-old woman who developed progressive quadriplegia 10 days after receiving multiple honeybee venom sting acupuncture treatments. The electrophysiological findings were consistent with Guillain-Barré syndrome (GBS). The temporal relationship between the development of GBS and honeybee venom sting acupuncture is suggestive of a cause-and-effect relationship, although the precise pathophysiology and causative components in honeybee venom need to be verified.

Mast cells in human health and disease

Mast cells are primarily known for their role in defense against pathogens, particularly bacteria; neutralization of venom toxins; and for triggering allergic responses and anaphylaxis. In addition to these direct effector functions, activated mast cells rapidly recruit other innate and adaptive immune cells and can participate in "tuning" the immune response. In this review we touch briefly on these important functions and then focus on some of the less-appreciated roles of mast cells in human disease including cancer, autoimmune inflammation, organ transplant, and fibrosis. Although it is difficult to formally assign causal roles to mast cells in human disease, we offer a general review of data that correlate the presence and activation of mast cells with exacerbated inflammation and disease progression. Conversely, in some restricted contexts, mast cells may offer protective roles. For example, the presence of mast cells in some malignant or cardiovascular diseases is associated with favorable prognosis. In these cases, specific localization of mast cells within the tissue and whether they express chymase or tryptase (or both) are diagnostically important considerations. Finally, we review experimental animal models that imply a causal role for mast cells in disease and discuss important caveats and controversies of these findings.

Comparison of moderate to severe systemic reactions with honeybee and wasp in children

BACKGROUND

The effect of the type of Hymenoptera on the severity of systemic reactions (SRs) is a controversial issue. The aim of the present study was to evaluate demographic, clinical, diagnostic, and therapeutic features of moderate-to-severe SRs in children with venom hypersensitivity and to compare the role of the honeybee and wasp stings in these reactions.

METHODS

Data on children with moderate-to-severe SRs after a Hymenoptera sting were retrospectively collected for a 17-year period.

RESULTS

A total of 55 children with moderate-to-severe SRs (wasp: 44, honeybee: 11) to venom stings were included in the study. In the honeybee group, comorbid allergic rhinitis and any type of atopic disease was more frequent compared to the wasp group (p = 0.009 and p = 0.01, respectively). In 50.9% of the children, family history of SR to the same venom type was higher in the honeybee group (p = 0.02). Dyspnea was more frequent in the wasp, and cyanosis was more frequent in the honeybee compared to each other (p = 0.02 and p < 0.001, respectively). Prick tests results were significantly different between the groups (p = 0.038). There was no difference between honeybee and wasp in moderate-to-severe SR groups in terms of seasonal tendency, age at admission, age at first SR, gender, previous history of SR, sting localization, latency, and affected organ systems (p > 0.05 for each).

CONCLUSION

Moderate-to-severe SRs with honeybee and wasp venoms in children may differ in the severity of respiratory symptoms/signs at presentation, in addition to comorbidity of atopic diseases and family history of the SRs.

Reactions to honeybee stings: an allergic prospective

PURPOSE OF REVIEW

The purpose of this article is to provide a brief overview of the events involved in honeybee allergy and to concisely update the reader on progress toward knowledge of honeybee venom (HBV), strides in solving diagnostic difficulties, and advancements in improving safety and efficacy of HBV immunotherapy.

RECENT FINDINGS

It is well known that honeybee allergy is unique in venom allergen and protein composition, diagnostic challenges, and immunotherapy safety and efficacy. Many new honeybee allergens have been recognized. Advances in testing, evaluation, and extract manipulation methods, many using recombinant technology, have allowed a greater ability to help with honeybee allergy diagnosis and resultant improvement in immunotherapy safety and evaluation of immunotherapy efficacy.

SUMMARY

In an effort to address many honeybee allergy concerns, specific advances have been recently made. Some recently characterized honeybee allergens appear to be major contributors to honeybee allergy. In the setting of double-positivity, cross-reacting carbohydrate determinants and other cross-reacting components in HBV have made diagnosis of honeybee allergy challenging. Recombinant technology, including component-resolved diagnostics, and other evolving testing methods should help clarify double-positivity, if not now, in the very near future. Purified HBV and possibly depot formulations for immunotherapy appear to make it more well tolerated. Recombinant methods may help with evaluation of immunotherapy's safety and efficacy.

Analysis of cytotoxicity of melittin on adherent culture of human endothelial cells reveals advantage of fluorescence microscopy over flow cytometry and haemocytometer assay

Melittin, from the honeybee venom, is a membrane active protein, whose cytotoxicity to human endothelial cells has not been described yet. In this work, we studied its time-dependent cytotoxicity on human umbilical vein endothelial cells (HUVECs). Since HUVECs grow in culture as adherent cells, suspension of cells is required before measuring cytotoxicity with a haemocytometer or flow cytometry. Therefore, we also tried to discover whether the result of cytotoxicity tests of melittin is influenced by the preparation of the cell suspension. For this purpose, we compared the results of haemocytometer-based trypan blue assay and flow cytometry using 7-aminoactinomycin D (7-AAD) with results of fluorescence microscopy using 7-AAD and 4', 6-diamidino-2-phenylindole (DAPI). Melittin over 60 min exposure evoked a rapid decline in the survival of HUVEC. After 60 min exposure to melittin, the phase contrast microscopy demonstrated massive necrosis in the remaining attached cells. Fluorescence microscopy detected both viable and non-viable cells in adequate proportions at all exposure times, whereas haemocytometer-based assay and flow cytometry highly underestimated the percentage of non-viable cells or even failed to detect any dead cells. Our data clearly indicate that the induction of large-scale damage to adherent endothelial cells by melittin results in a loss of the majority of necrotic cells during sample preparation for flow cytometry or a haemocytometer-based assay. In the case of adherent cell culture, therefore, fluorescence microscopy was shown to be a more appropriate method for quantitative analysis of cell death caused by a fast-acting cytolytic toxin such as melittin.

An update on venom allergy

PURPOSE OF REVIEW

Allergic reactions to stinging insects may be unexpected, frightening, and severe. A clear understanding of recent advances in the field facilitates appropriate care of children who experience severe reactions to hymenoptera stings.

RECENT FINDINGS

Recent investigations have underscored the importance of appropriate patient selection for potentially life-saving venom immunotherapy. Venom immunotherapy is effective in preventing future anaphylaxis from hymenoptera stings. Immunotherapy is indicated for patients with a history of anaphylaxis. Children who develop large local swelling or strictly cutaneous systemic reactions generally do not require immunotherapy. Component resolved diagnostic testing has been investigated to clarify the possibility of multiple venom allergies in patients with sensitization to multiple venoms.

SUMMARY

Rapid recognition and treatment of anaphylaxis are critical. Subsequent education about avoiding future stings and attention to emergency preparedness with appropriate prescription of self-injectable epinephrine is important. Referral of patients who have experienced venom-associated anaphylaxis for possible venom immunotherapy can prevent future severe episodes of anaphylaxis resulting from stings.

Honeybee venom immunotherapy: certainties and pitfalls

The honeybee is an interesting insect because of the fundamental agricultural role it plays, together with the composition of its venom, which presents new diagnostic and immunotherapeutic challenges. This article examines various aspects of honeybee venom allergy from epidemiology to diagnosis and treatment, with special emphasis on venom immunotherapy (VIT). Honeybee venom allergy represents a risk factor for severe systemic reaction in challenged allergic patients, for the diminished effectiveness of VIT, for more frequent side effects during VIT and relapse after cessation of treatment. Some strategies are available for reducing the risk of honeybee VIT-induced side effects; however, there is considerable room for further improvement in these all-important areas. At the same time, sensitized and allergic beekeepers represent unique populations for epidemiological, venom allergy immunopathogenesis and VIT mechanism studies.

Role of the inflammasome in defense against venoms

Venoms consist of a complex mixture of toxic components that are used by a variety of animal species for defense and predation. Envenomation of mammalian species leads to an acute inflammatory response and can lead to the development of IgE-dependent venom allergy. However, the mechanisms by which the innate immune system detects envenomation and initiates inflammatory and allergic responses to venoms remain largely unknown. Here we show that bee venom is detected by the NOD-like receptor family, pyrin domain-containing 3 inflammasome and can trigger activation of caspase-1 and the subsequent processing and unconventional secretion of the leaderless proinflammatory cytokine IL-1β in macrophages. Whereas activation of the inflammasome by bee venom induces a caspase-1-dependent inflammatory response, characterized by recruitment of neutrophils to the site or envenomation, the inflammasome is dispensable for the allergic response to bee venom. Finally, we find that caspase-1-deficient mice are more susceptible to the noxious effects of bee and snake venoms, suggesting that a caspase-1-dependent immune response can protect against the damaging effects of envenomation.