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Carli T, Locatelli I, Košnik M, Kukec A. The Prevalence of Self-Reported Systemic Allergic Reaction to Hymenoptera Venom in Beekeepers Worldwide: A Systematic Literature Review and Meta-Analysis. Zdr Varst 2024; 63:152-159. [PMID: 38881633 PMCID: PMC11178027 DOI: 10.2478/sjph-2024-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/19/2024] [Indexed: 06/18/2024] Open
Abstract
Background Beekeepers represent a high-allergic risk population group due to their unavoidable seasonal or persistent exposure to the elicitors of Hymenoptera venom allergy, bees in particular. A systematic literature review and meta-analysis aimed to estimate the prevalence of self-reported systemic allergic reaction to Hymenoptera venom among beekeepers worldwide. Methods We rigorously reviewed and conducted meta-analysis on observational studies retrieved from seven electronic databases (MEDLINE via PubMed, Web of Science Core Collection, Scopus, Academic Search Complete, ScienceDirect, Cumulative Index to Nursing and Allied Health Literature, Zoological Record), spanning data from inception to August 1, 2023. The Joanna Briggs Institute Prevalence Critical Appraisal Tool was employed to assess the risk of bias. A meta-analysis was conducted to synthesize evidence. Results Out of 468 studies, eight original articles met the inclusion criteria. The estimated overall lifetime and one-year prevalence of self-reported systemic allergic reaction to bee venom were 23.7% (95% CI: 7.7-53.4) and 7.3% (95% CI: 5.8-9.2), respectively. The estimated lifetime prevalence of self-reported systemic allergic reaction to bee venom for grades III-IV (severe systemic allergic reaction) was 6.0% (95% CI: 3.0-11.7). In general, substantial heterogeneity and a high risk of bias were observed across the majority of studies. The impact of geographical location and climate differences on the estimated lifetime prevalence is suggestive for severe systemic allergic reaction. Conclusions Future observational cross-sectional studies should employ rigorous study designs, using validated questionnaires, and thoroughly report the observed health outcomes, verified by physicians.
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Affiliation(s)
- Tanja Carli
- University of Ljubljana, Faculty of Medicine, Vrazov trg 2, 1000 Ljubljana, Slovenia
- National Institute of Public Health, Trubarjeva cesta 2, 1000 Ljubljana, Slovenia
| | - Igor Locatelli
- University of Ljubljana, Department of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, Aškerčeva cesta 7, 1000 Ljubljana
| | - Mitja Košnik
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik 36, 4204 Golnik, Slovenia
- University of Ljubljana, Faculty of Medicine, Chair of Internal Medicine, Zaloška cesta 7, 1000 Ljubljana, Slovenia
| | - Andreja Kukec
- National Institute of Public Health, Trubarjeva cesta 2, 1000 Ljubljana, Slovenia
- University of Ljubljana, Chair of Public Health, Zaloška cesta 4, 1000 Ljubljana, Slovenia
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Charoenwikkai S, Intapun P, Lao-Araya M. Bee Sting Injuries in Thailand's High Apicultural Area: Outcome, Risk and Treatment Patterns. Risk Manag Healthc Policy 2024; 17:1837-1845. [PMID: 39050091 PMCID: PMC11268765 DOI: 10.2147/rmhp.s470007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
Objective This study aims to assess the clinical outcomes and risk factors associated with severe systemic reactions following bee stings, focusing on patients treated at Pa-Sang Community Hospital, located in Lamphun Province, Thailand, which is recognized as one of the country's largest apicultural areas. Methods A retrospective review was conducted, utilizing electronic medical records with ICD-10 coding, of patients treated for bee sting injuries at the Emergency Department of Pa-Sang Hospital from January 2015 to December 2019. Results This analysis included a total of 591 bee sting events involving 533 patients. The average incidence of bee sting injuries was 31.3 per 10,000 Emergency Department visits, with 55% being male. A significant majority (86%) of events occurred outside the patients' home area. Notably, the head or extremities (49%) were the most common anatomical sites stung. Systemic reactions were observed in 44% of cases, with 96 visits (16%) diagnosed as anaphylaxis. Epinephrine injection was administered in 77% of these cases, and fortunately, no fatal anaphylactic reactions were recorded. Protective factors for anaphylaxis and severe systemic reactions after bee stings included age less than 15 years old and stings on extremities. Conversely, having more than ten bee stings and seeking Emergency Department treatment within 60 minutes of being stung were identified as significant risk factors. Conclusion Bee sting injuries were a common presentation at the hospital situated in the high apicultural area, and severe systemic reactions were observed. This study highlights the need for comprehensive interventions to mitigate the increased risk of bee-related accidents in communities with thriving apicultural industries.
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Affiliation(s)
- Sirithanan Charoenwikkai
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Khanu Woralaksaburi Hospital, Saen To, Khanu Woralaksaburi, Kamphaeng Phet, 62130, Thailand
| | - Premmika Intapun
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Mongkol Lao-Araya
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
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3
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Ünal D, Eyice-Karabacak D, Kutlu A, Demir S, Tüzer C, Arslan AF, Işık SR, Gelincik A. Oral immunotherapy in alpha-gal red meat allergy: Could specific IgE be a potential biomarker in monitoring management? Allergy 2023; 78:3241-3251. [PMID: 37545316 DOI: 10.1111/all.15840] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/21/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Oral immunotherapy (OIT) is a promising treatment for food allergies. Our aim was to establish the long-term safety and efficacy of a novel red meat (RM) OIT in galactose-alpha-1,3-galactose (alpha-gal) allergy in adults. METHODS Out of 20 patients with confirmed RM allergy, five (41.66%) underwent an early OIT, seven (58.33%) underwent a delayed protocol and eight patients who were not desensitized formed the patient control group. 15 and 27 day RM OIT for early-onset and delayed-onset alpha-gal allergy were administered, respectively. Desensitized patients were recommended to continue eating at least 100 g RM every day for 6 months and every other day in the following 6 months. After a year, the consumption was recommended 2/3 times in a week. Patients were followed up with skin tests with commercial beef and lamb extracts, fresh raw/cooked beef and lamb and cetuximab and also with serum alpha-gal specific Immunoglobulin-E (sIgE) in the first and fifth years. RESULTS All patients who underwent OIT became tolerant to RM. During the 5 year follow-up, the median alpha-gal sIgE concentration gradually decreased in nine patients who consumed RM uneventfully while remained unchanged in the control group (p = .016). In two patients, rare tick bites acted as inducers of hypersensitivity reactions with concomitant elevation of alpha-gal sIgE concentrations whereas one patient with low follow-up alpha-gal sIgE concentrations consumed RM uneventfully after frequent tick bites. CONCLUSIONS Our study showed the long-term safety and efficacy of alpha-gal OIT. Additionally, alpha-gal sIgE seems to be a potential biomarker to monitor OIT.
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Affiliation(s)
- D Ünal
- Division of Immunology and Allergy Diseases, Internal Medicine Department, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - D Eyice-Karabacak
- Division of Immunology and Allergy Diseases, Internal Medicine Department, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A Kutlu
- Medical Park Hospital Ordu, Ordu, Turkey
| | - S Demir
- Division of Immunology and Allergy Diseases, Internal Medicine Department, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - C Tüzer
- Division of Immunology and Allergy Diseases, Internal Medicine Department, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - A F Arslan
- Division of Immunology and Allergy Diseases, Internal Medicine Department, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - S R Işık
- Division of Immunology and Allergy Diseases, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - A Gelincik
- Division of Immunology and Allergy Diseases, Internal Medicine Department, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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4
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Gschwend A, Helbling A. Allergic Reactions to Stinging and Biting Insects. Clin Immunol 2023. [DOI: 10.1016/b978-0-7020-8165-1.00047-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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5
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Hollstein MM, Matzke SS, Lorbeer L, Forkel S, Fuchs T, Lex C, Buhl T. Intracutaneous Skin Tests and Serum IgE Levels Cannot Predict the Grade of Anaphylaxis in Patients with Insect Venom Allergies. J Asthma Allergy 2022; 15:907-918. [PMID: 35836970 PMCID: PMC9274911 DOI: 10.2147/jaa.s367272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background Allergies against Hymenoptera venoms are a major cause of severe anaphylaxis. Risk assessment for subjects with suspected allergy is difficult because there are currently no biomarkers that predict the likelihood of high-grade anaphylaxis other than several associated comorbidities. Objective We investigated the relationship between the severity of anaphylaxis and the results of intracutaneous skin tests (ICTs) together with serum levels of tryptase, total IgE, and venom-specific IgE, IgG, and IgG4. Methods We performed a retrospective evaluation of 194 patients who presented to a single medical center with allergies to bee venoms (Apis mellifera, Bombus spp.; n=24, 12.4%), vespid venoms (Vespula spp., Vespa spp., Polistes spp.; n=169, 87.1%), or both (n=1, 0.5%). Results Index bee stings occurred earlier in the year than vespid stings, although the latter were reported more frequently overall. On average, subjects who previously experienced grade IV anaphylaxis required higher dosages of venom to yield positive ICTs than those who exhibited lower grade responses. Patients diagnosed with grade IV anaphylaxis exhibited significantly lower levels of venom-specific IgE and IgG and trended toward elevated levels of tryptase. No significant differences in average levels of venom-specific IgG4 and total IgE were observed. Conclusion Our findings reveal that intracutaneous skin testing and levels of venom-specific IgE do not predict the degree of anaphylaxis that develops in patients with venom allergy. Furthermore, the month of the index sting is not a reliable means to differentiate bee from vespid stings in patients presenting with an uncertain history.
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Affiliation(s)
- Moritz M Hollstein
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
| | - Silke S Matzke
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
| | - Lisa Lorbeer
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
| | - Susann Forkel
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
| | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
| | - Christiane Lex
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology with Pediatric Pneumology, University Medical Centre Göttingen, Göttingen, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Centre Göttingen, Göttingen, Germany
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6
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Carli T, Locatelli I, Košnik M, Kukec A. Epidemiology and risk factors of self-reported systemic allergic reactions to a Hymenoptera venom in beekeepers worldwide: a protocol for a systematic review of observational studies. BMJ Open 2022; 12:e058130. [PMID: 35790330 PMCID: PMC9258514 DOI: 10.1136/bmjopen-2021-058130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Systemic allergic reaction (SAR) to a Hymenoptera venom is a potentially life-threatening disorder. The rate of SAR between beekeepers in comparison with a healthy individual is different. The risk for an SAR is particularly high in beekeepers due to their persistent or seasonal exposure to the stinging Hymenoptera. We aim to provide a critical appraisal and a synthesis of evidence-based data from epidemiological observational studies, focusing on SARs to a Hymenoptera venom and the associated risk factors for SARs in beekeepers worldwide. METHODS AND ANALYSIS Searching will include seven electronic databases for published studies without language restrictions, from inception up to 3 August 2021, and it will be rerun for all electronic databases prior publication. Only epidemiological observational studies in beekeepers will be included. The risk of bias in the included studies will be appraised by using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies and the Newcastle-Ottawa Scale, adapted for cross-sectional studies. For the certainty of evidence, the Grading of Recommendations Assessment, Development and Evaluation approach will be used. Qualitative synthesis will be presented in a tabulated format with the selected characteristics across primary studies and the main outcome of interest. A meta-analysis is planned to be performed if there will be a sufficient number of homogeneous studies with complete data. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 statement will guide the reporting of this systematic literature review. ETHICS AND DISSEMINATION No ethics approval is needed to conduct the systematic literature review since it will be solely based on the published literature. Findings will be disseminated through the relevant conferences, peer-review and open-access journals.PROSPERO registration numberCRD42021260922.
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Affiliation(s)
- Tanja Carli
- National Institute of Public Health of the Republic of Slovenia, Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
| | - Igor Locatelli
- University of Ljubljana, Faculty of Pharmacy, Department of Social Pharmacy, Ljubljana, Slovenia
| | - Mitja Košnik
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
- University of Ljubljana, Faculty of Medicine, Chair of Internal Medicine, Ljubljana, Slovenia
| | - Andreja Kukec
- National Institute of Public Health of the Republic of Slovenia, Ljubljana, Slovenia
- University of Ljubljana, Faculty of Medicine, Chair of Public Health, Ljubljana, Slovenia
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Li N, Aoki V, Liu Z, Prisayanh P, Valenzuela JG, Diaz LA. From Insect Bites to a Skin Autoimmune Disease: A Conceivable Pathway to Endemic Pemphigus Foliaceus. Front Immunol 2022; 13:907424. [PMID: 35693761 PMCID: PMC9186141 DOI: 10.3389/fimmu.2022.907424] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/28/2022] [Indexed: 01/05/2023] Open
Abstract
In the endemic variants of pemphigus foliaceus (PF), in Brazil and Tunisia, patients generate pathogenic IgG4 anti-desmoglein 1 autoantibodies. Additionally, these patients possess antibodies against salivary proteins from sand flies that react with Dsg1, which may lead to skin disease in susceptible individuals living in endemic areas. This minireview focuses on recent studies highlighting the possible role of salivary proteins from Lutzomyia longipalpis (L. longipalpis) in EPF from Brazil and Phlebotomus papatasi (P. papatasi) in EPF from Tunisia. We will briefly discuss the potential mechanisms of molecular mimicry and epitope spreading in the initiation and development of endemic PF (EPF) in Brazil and Tunisia.
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Affiliation(s)
- Ning Li
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Valeria Aoki
- Department of Dermatology, Faculdade de Medicina Facultade de Medicina, Universidade de Sao Paulo (FMUSP), Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Zhi Liu
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Phillip Prisayanh
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jesus G. Valenzuela
- Vector Molecular Biology Section, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States
| | - Luis A. Diaz
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Luis A. Diaz,
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8
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Perčič S, Bojanić L, Košnik M, Kukec A. Natural History of the Hymenoptera Venom Sensitivity Reactions in Adults: Study Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074319. [PMID: 35409999 PMCID: PMC8998790 DOI: 10.3390/ijerph19074319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 12/10/2022]
Abstract
Background: Allergic reactions to Hymenoptera stings can have varying levels of severity, according to the Müller grading system. Methods: By an epidemiological concept, this is a retrospective cohort study. The observed cohort was represented by patients referred to the University Clinic Golnik due to Hymenoptera allergic reaction in the period from 1997 to 2015. From the immunological database of the University Clinic Golnik, we obtained laboratory data (sIgE, skin tests and basophil activation test). The clinical characteristics of patients were obtained from BIRPIS. With the help of a questionnaire, which was sent to each patient in the period from May 2019 to April 2021, we obtained epidemiological data. For the assessment of the association between the severity of allergic reaction for the observed outcome, the severity of the first allergic reaction after Hymenoptera sting was used. Other variables were grouped according to risk factors. Discussion: We will identify the risk factors that could play an important role in a severe systemic reaction: the aetiology of the Hymenoptera sting, sex, age, history and severity of previous systemic reactions, being re-stung in an interval of two months, the frequency of re-stings, atopy, genetic predisposition, preventive medication use, other medication use, beekeeping or living next to beehives and why immunotherapy was not taken. Laboratory data will also be analysed to determine if there is any association with laboratory tests and the severity of the allergic reactions after Hymenoptera stings. Conclusions: Several new approaches are introduced in the study design. The most important is that the protocol covers epidemiological data gained from the questionnaire, as well as clinical data gained from the Immunological database and BIRPIS database. We expect to obtain significant results that will explain the risk factors for the natural history of Hymenoptera sting allergic reactions and will help allergologists, as well as general doctors, when facing those patients allergic to Hymenoptera venom without immunotherapy.
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Affiliation(s)
- Simona Perčič
- National Institute of Public Health, Centre for Environmental Health, Zaloška 29, 1000 Ljubljana, Slovenia;
- Correspondence:
| | - Lidija Bojanić
- The University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik 36, 4204 Golnik, Slovenia; (L.B.); (M.K.)
| | - Mitja Košnik
- The University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik 36, 4204 Golnik, Slovenia; (L.B.); (M.K.)
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Andreja Kukec
- National Institute of Public Health, Centre for Environmental Health, Zaloška 29, 1000 Ljubljana, Slovenia;
- Department of Public Health, Faculty of Medicine, University of Ljubljana, Zaloška 4, 1000 Ljubljana, Slovenia
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9
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Koksal ZG, Uysal P. Successful use of a subcutaneous injection port for modified cluster venom immunotherapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:879-881.e1. [PMID: 34768000 DOI: 10.1016/j.jaip.2021.10.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Zeynep Gulec Koksal
- Aydin Adnan Menderes University Faculty of Medicine, Department of Pediatric Allergy and Immunology, Aydin, Turkey.
| | - Pinar Uysal
- Aydin Adnan Menderes University Faculty of Medicine, Department of Pediatric Allergy and Immunology, Aydin, Turkey
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Starkl P, Gaudenzio N, Marichal T, Reber LL, Sibilano R, Watzenboeck ML, Fontaine F, Mueller AC, Tsai M, Knapp S, Galli SJ. IgE antibodies increase honeybee venom responsiveness and detoxification efficiency of mast cells. Allergy 2022; 77:499-512. [PMID: 33840121 PMCID: PMC8502784 DOI: 10.1111/all.14852] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/01/2021] [Accepted: 02/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND In contrast to their clearly defined roles in allergic diseases, the physiologic functions of Immunoglobulin E antibodies (IgEs) and mast cells (MCs) remain enigmatic. Recent research supports the toxin hypothesis, showing that MCs and IgE-related type 2 immune responses can enhance host defense against certain noxious substances, including honeybee venom (BV). However, the mechanisms by which MCs can interfere with BV toxicity are unknown. In this study, we assessed the role of IgE and certain MC products in MC-mediated BV detoxification. METHODS We applied in vitro and in vivo fluorescence microscopyimaging, and flow cytometry, fibroblast-based toxicity assays and mass spectrometry to investigate IgE-mediated detoxification of BV cytotoxicity by mouse and human MCs in vitro. Pharmacologic strategies to interfere with MC-derived heparin and proteases helped to define the importance of specific detoxification mechanisms. RESULTS Venom-specific IgE increased the degranulation and cytokine responses of MCs to BV in vitro. Passive serum sensitization enhanced MC degranulation in vivo. IgE-activated mouse or human MCs exhibited enhanced potential for detoxifying BV by both proteolytic degradation and heparin-related interference with toxicity. Mediators released by IgE-activated human MCs efficiently degraded multiple BV toxins. CONCLUSIONS Our results both reveal that IgE sensitization enhances the MC's ability to detoxify BV and also assign efficient toxin-neutralizing activity to MC-derived heparin and proteases. Our study thus highlights the potential importance of IgE, MCs, and particular MC products in defense against BV.
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Affiliation(s)
- Philipp Starkl
- Laboratory of Infection Biology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- CeMM - Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Nicolas Gaudenzio
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Toulouse Institute for Infectious and Inflammatory Diseases, INSERM UMR1291, CNRS, UMR5051, University of Toulouse III, Toulouse, France
| | - Thomas Marichal
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- GIGA-Research and Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Laurent L. Reber
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Toulouse Institute for Infectious and Inflammatory Diseases, INSERM UMR1291, CNRS, UMR5051, University of Toulouse III, Toulouse, France
| | - Riccardo Sibilano
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA
| | - Martin L. Watzenboeck
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Frédéric Fontaine
- CeMM - Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - André C. Mueller
- CeMM - Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Mindy Tsai
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA
| | - Sylvia Knapp
- Laboratory of Infection Biology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- CeMM - Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Stephen J. Galli
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
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11
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Foo ACY, Mueller GA. Abundance and Stability as Common Properties of Allergens. FRONTIERS IN ALLERGY 2021; 2:769728. [PMID: 35386965 PMCID: PMC8974735 DOI: 10.3389/falgy.2021.769728] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/04/2021] [Indexed: 01/06/2023] Open
Abstract
There have been many attempts to identify common biophysical properties which differentiate allergens from their non-immunogenic counterparts. This review will focus on recent studies which examine two such factors: abundance and stability. Anecdotal accounts have speculated that the elevated abundance of potential allergens would increase the likelihood of human exposure and thus the probability of sensitization. Similarly, the stability of potential allergens dictates its ability to remain a viable immunogen during the transfer from the source to humans. This stability could also increase the resilience of potential allergens to both gastric and endosomal degradation, further skewing the immune system toward allergy. Statistical analyses confirm both abundance and stability as common properties of allergens, while epidemiological surveys show a correlation between exposure levels (abundance) and allergic disease. Additional studies show that changes in protein stability can predictably alter gastric/endosomal processing and immunogenicity, providing a mechanistic link between stability and allergenicity. However, notable exceptions exist to both hypotheses which highlight the multifaceted nature of immunological sensitization, and further inform our understanding of some of these other factors and their contribution to allergic disease.
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Affiliation(s)
| | - Geoffrey A. Mueller
- Genome Integrity and Structural Biology Laboratory, National Institute of Environmental Health Sciences, Durham, NC, United States
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12
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The prevalence of Api m 10 sensitization and the modification of immunotherapy in bee venom allergy. Postepy Dermatol Alergol 2021; 38:699-700. [PMID: 34658717 PMCID: PMC8501423 DOI: 10.5114/ada.2021.108922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/26/2019] [Indexed: 12/02/2022] Open
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13
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Liu D, Fu T, Li W, Xu F, Wang P, Jiang Y. Observation on the efficacy of hemoperfusion combined with methylprednisolone in the treatment of heart and liver function injury caused by bee venom sting. Panminerva Med 2021; 64:292-293. [PMID: 34664490 DOI: 10.23736/s0031-0808.21.04570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Tian Fu
- Hospital of Hanzhong City, Hanzhong, China
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Burzyńska M, Piasecka-Kwiatkowska D. A Review of Honeybee Venom Allergens and Allergenicity. Int J Mol Sci 2021; 22:ijms22168371. [PMID: 34445077 PMCID: PMC8395074 DOI: 10.3390/ijms22168371] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 12/15/2022] Open
Abstract
Honeybee venom is a source of proteins with allergenic properties which can result in in various symptoms, ranging from local reactions through to systematic life-threatening anaphylaxis, or even death. According to the World Allergy Organization (WAO), honeybee venom allergy is one of the most common causes of anaphylaxis. Among the proteins present in honeybee venom, 12 protein fractions were registered by the World Health Organization’s Allergen Nomenclature Sub-Committee (WHO/IUIS) as allergenic. Most of them are highly immunogenic glycoproteins that cross-react with IgE and, as a consequence, may give false positive results in allergy diagnosis. Allergenic fractions are different in terms of molecular weight and biological activity. Eight of these allergenic fractions have also been identified in honey. This explains frequent adverse reactions after consuming honey in people allergic to venom and sheds new light on the causes of allergic symptoms in some individuals after honey consumption. At the same time, it also indicates the possibility of using honey as a natural source of allergen in specific immunotherapy.
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New Biomarkers of Hymenoptera Venom Allergy in a Group of Inflammation Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084011. [PMID: 33920429 PMCID: PMC8069624 DOI: 10.3390/ijerph18084011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 01/30/2023]
Abstract
Hymenoptera venom allergy significantly affects the quality of life. Due to the divergences in the results of the available test and clinical symptoms of patients, the current widely applied diagnostic methods are often insufficient to classify patients for venom immunotherapy (VIT). Therefore it is still needed to search for new, more precise, and accurate diagnostic methods. Hence, this research aimed to discover new biomarkers of Hymenoptera venom allergy in a group of inflammation factors using set of multi-marker Bioplex panel. The adoption of a novel methodology based on Luminex/xMAP enabled simultaneous determination of serum levels of 37 different inflammatory proteins in one experiment. The study involved 21 patients allergic to wasp and/or honey bee venom and 42 healthy participants. According to univariate and multivariate statistics, soluble CD30/tumor necrosis factor receptor superfamily, member 8 (sCD30/TNFRSF8), and the soluble tumor necrosis factor receptor 1 (sTNF-R1) may be considered as effective prognostic factors, their circulating levels were significantly decreased in the allergy group (p-value < 0.05; the Area Under the Curve (AUC) ~0.7; Variable Importance in Projection (VIP) scores >1.2). The obtained results shed new light on the allergic inflammatory response and may contribute to modification and improvement of the diagnostic and monitoring methods. Further, large-scale studies are still needed to explain mechanisms of action of studied compounds and to definitively prove their usefulness in clinical practice.
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Soriano-Gomis V, Cabrera-Beyrouti R, Serrano-Delgado P, Jimenez-Rodriguez TW, Gómez MB, Fernandez-Sanchez J. Epidemiology of Hymenoptera venom allergy in the Valencia Fire Brigade (Spain). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:1037-1038.e2. [DOI: 10.1016/j.jaip.2020.09.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/08/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
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Hızlı Demirkale Z, Yücel E, Sipahi Çimen S, Süleyman A, Özdemir C, Kara A, Tamay Z. Venom allergy and knowledge about anaphylaxis among beekeepers and their families. Allergol Immunopathol (Madr) 2020; 48:640-645. [PMID: 32460992 DOI: 10.1016/j.aller.2020.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/15/2020] [Accepted: 01/29/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Beekeepers and their families are at an increased risk of life-threatening anaphylaxis due to recurrent bee-sting exposures. OBJECTIVE The aim of this study is to evaluate the demographic features, previous history of anaphylaxis among beekeepers and their family members, and their knowledge about the symptoms and management of anaphylaxis. METHODS A standardized questionnaire was administered to beekeepers during the 6th International Beekeeping and Pine Honey Congress held in 2018, in Mugla, Turkey. Additionally, food-service staff from restaurants were surveyed as an occupational control group about their knowledge about anaphylaxis. RESULTS Sixty-nine beekeepers (82.6% male, mean age 48.4±12.0 years) and 52 restaurant staff (46.2% male, mean age 40.5±10.0 years) completed the questionnaire. Awareness of the terms 'anaphylaxis' and 'epinephrine auto-injector' among the beekeepers were 55.1% and 30.4% and among the restaurant staff were 23.1% and 3.8%, respectively. Of the beekeepers, 74% were able to identify the potential symptoms of anaphylaxis among the given choices; 2.9% and 5.8% reported anaphylaxis related to bee-stings in themselves and in their family members, respectively. None of the restaurant staff had experienced or encountered anaphylaxis before but 3.8% of their family members had anaphylaxis and those reactions were induced by drugs. CONCLUSION It is essential that implementation of focused training programs about anaphylaxis symptoms and signs as well as practical instructions of when and how to use an epinephrine auto-injector will decrease preventable morbidities and mortalities due to bee-stings in this selected high-risk population of beekeepers and their family members, as well as other fieldworkers under risk.
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Galli SJ, Metz M, Starkl P, Marichal T, Tsai M. Mast cells and IgE in defense against lethality of venoms: Possible "benefit" of allergy[]. ALLERGO JOURNAL INTERNATIONAL 2020; 29:46-62. [PMID: 33224714 PMCID: PMC7673288 DOI: 10.1007/s40629-020-00118-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/20/2019] [Indexed: 01/15/2023]
Abstract
Physicians think of mast cells and IgE primarily in the context of allergic disorders, including fatal anaphylaxis. This 'bad side' of mast cells and IgE is so well accepted that it can be difficult to think of them in other contexts, particularly those in which they may have beneficial functions. However, there is evidence that mast cells and IgE, as well as basophils (circulating granulocytes whose functions partially overlap with those of mast cells), can contribute to host defense as components of adaptive type 2 immune responses to helminths, ticks and certain other parasites. Accordingly, allergies often are conceptualized as "misdirected" type 2 immune responses, in which IgE antibodies are produced against any of a diverse group of apparently harmless antigens, and against components of animal venoms. Indeed, certain unfortunate patients who have become sensitized to venoms develop severe IgE-associated allergic reactions, including fatal anaphylaxis, upon subsequent venom exposure. In this review, we will describe evidence that mast cells can enhance innate resistance, and survival, to challenge with reptile or arthropod venoms during a first exposure to such venoms. We also will discuss findings indicating that, in mice surviving an initial encounter with venom, acquired type 2 immune responses, IgE antibodies, the high affinity IgE receptor (FcεRI), and mast cells can contribute to acquired resistance to the lethal effects of both honeybee venom and Russell's viper venom. These findings support the hypothesis that mast cells and IgE can help protect the host against venoms and perhaps other noxious substances.
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Affiliation(s)
- Stephen J. Galli
- Department of Pathology and the Sean N. Parker Center for Allergy Research, Stanford University School of Medicine, Stanford, California, 94305; USA
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California, 94305; USA
| | - Martin Metz
- Department of Dermatology and Allergy, Charité – Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Philipp Starkl
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, 1090 Vienna, Austria
- Department of Medicine 1, Laboratory of Infection Biology, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Marichal
- GIGA-Research and Faculty of Veterinary Medicine, University of Liege, 4000 Liege, Belgium
| | - Mindy Tsai
- Department of Pathology and the Sean N. Parker Center for Allergy Research, Stanford University School of Medicine, Stanford, California, 94305; USA
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Stoevesandt J, Sturm GJ, Bonadonna P, Oude Elberink JN, Trautmann A. Risk factors and indicators of severe systemic insect sting reactions. Allergy 2020; 75:535-545. [PMID: 31194889 DOI: 10.1111/all.13945] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/16/2019] [Accepted: 06/07/2019] [Indexed: 01/06/2023]
Abstract
Hymenoptera venom allergy ranks among the top three causes of anaphylaxis worldwide, and approximately one-quarter of sting-induced reactions are classified as severe. Fatal sting reactions are exceedingly rare, but certain factors may entail a considerably higher risk. Delayed administration of epinephrine and upright posture are situational risk factors which may determine an unfavorable outcome of the acute anaphylactic episode and should be addressed during individual patient education. Systemic mastocytosis and senior age are major, unmodifiable long-term risk factors and thus reinforce the indication for venom immunotherapy. Vespid venom allergy and male sex likewise augment the risk of severe or even fatal reactions. Further studies are required to assess the impact of specific cardiovascular comorbidities. Available data regarding potential effects of beta-blockers and/or ACE inhibitors in coexisting venom allergy are inconclusive and do not justify recommendations to discontinue guideline-directed antihypertensive treatment. The absence of urticaria/angioedema during sting-induced anaphylaxis is indicative of a severe reaction, serum tryptase elevation, and mast cell clonality. Determination of basal serum tryptase levels is an established diagnostic tool for risk assessment in Hymenoptera venom-allergic patients. Measurement of platelet-activating factor acetylhydrolase activity represents a complementary approach but is not available for routine diagnostic use.
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Affiliation(s)
- Johanna Stoevesandt
- Department of Dermatology, Venereology and Allergy & Allergy Center Mainfranken University Hospital Würzburg Würzburg Germany
| | - Gunter J. Sturm
- Department of Dermatology and Venereology Medical University of Graz Graz Austria
- Outpatient Allergy Clinic Reumannplatz Vienna Austria
| | - Patrizia Bonadonna
- Allergy Unit and Multidisciplinary Mastocytosis Outpatient Clinic Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Joanna N.G. Oude Elberink
- Department of Allergology & GRIAC Research Institute University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Axel Trautmann
- Department of Dermatology, Venereology and Allergy & Allergy Center Mainfranken University Hospital Würzburg Würzburg Germany
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Antolín-Amérigo D, Ruiz-León B, Vega-Castro A, de la Hoz Caballer B. Natural history of systemic reactions and risk factors in children and adults with Hymenoptera venom allergy. ALLERGO JOURNAL 2020. [DOI: 10.1007/s15007-020-0745-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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21
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Venom immunotherapy in Europe and the United States. ALLERGO JOURNAL 2020. [DOI: 10.1007/s15007-020-0747-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Galli SJ, Metz M, Starkl P, Marichal T, Tsai M. Mast cells and IgE in defense against lethality of venoms: Possible "benefit" of allergy*. ALLERGO JOURNAL 2020. [DOI: 10.1007/s15007-020-0746-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Sahiner UM, Durham SR. Hymenoptera Venom Allergy: How Does Venom Immunotherapy Prevent Anaphylaxis From Bee and Wasp Stings? Front Immunol 2019; 10:1959. [PMID: 31497015 PMCID: PMC6712168 DOI: 10.3389/fimmu.2019.01959] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/02/2019] [Indexed: 01/12/2023] Open
Abstract
Hymenoptera stings may cause both local and systemic allergic reactions and even life threatening anaphylaxis. Along with pharmaceutical drugs and foods, hymenoptera venom is one of the most common causes of anaphylaxis in humans. To date, no parameter has been identified that may predict which sensitized people will have a future systemic sting reaction (SSR), however some risk factors, such as mastocytosis and age >40 years are known. Venom immunotherapy (VIT) is the most effective method of treatment for people who had SSR, which is shown to be effective even after discontinuation of the therapy. Development of peripheral tolerance is the main mechanism during immunotherapy. It is mediated by the production of blocking IgG/IgG4 antibodies that may inhibit IgE dependent reactions through both high affinity (FcεRI) and low affinity (FcεRII) IgE receptors on mast cells, basophils and B cells. The generation of antigen specific regulatory T cells produces IL-10 and suppresses Th2 immunity and the immune responses shift toward a Th1-type response. B regulatory cells are also involved in the production of IL-10 and the development of long term immune tolerance. During VIT the number of effector cells in target organs also decreases, such as mast cells, basophils, innate type 2 lymphocytes and eosinophils. Several meta-analyses and randomized controlled studies have proved that VIT is effective for preventing SSR to a sting and improves the quality of life. In this review, the risk of SSR in venom allergy and how VIT changed this risk are discussed.
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Affiliation(s)
- Umit Murat Sahiner
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Pediatric Allergy Department, Hacettepe University School of Medicine, Ankara, Turkey
| | - Stephen R Durham
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
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25
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Abstract
Respiratory allergy including bronchial asthma and food allergy have gained epidemic character in the last decades in industrialized countries. Much has been learned with respect to the pathophysiology of allergic disease and this has facilitated specific therapies. Allergy is a chronic disease, and being so prevalent claims to search for evolutionary causes of the general susceptibility of humans as a species to react to environmental antigens in a Th2 type immune reaction with IgE production. In an evolutionary analysis of Allergy, necessary questions addressed in this review are "Why does IgE exist or why did IgE evolve?" as well as from the point of view of the mismatch hypothesis, "Why is there an Allergy epidemic?" Recent studies on the possible biological and protective role of IgE against parasites, arthropods, venoms or toxins are challenging the widely accepted definition of allergens as generally innocuous antigens. Combining the immunologic danger model and the toxin hypothesis for allergies, the allergic response could have evolved with an adaptive value and allergens could be proxies for other putative noxious agents. The last decades yielded with vast molecular data of allergens. With available bioinformatics tools, we therefore also describe that evolutionary theory could be applied to prevent allergy, estimate cross-reactivity, to design allergen-specific immunotherapy and to assess the risks of novel foods.
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26
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Helbling A, Müller UR. Allergic Reactions to Stinging and Biting Insects. Clin Immunol 2019. [DOI: 10.1016/b978-0-7020-6896-6.00043-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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27
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Ricciardi L, Papia F, Cataldo G, Giorgianni M, Spatari G, Gangemi S. Hymenoptera sting reactions in southern Italy forestry workers: our experience compared to reported data. Clin Mol Allergy 2018; 16:8. [PMID: 29686538 PMCID: PMC5902920 DOI: 10.1186/s12948-018-0087-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 03/24/2018] [Indexed: 12/13/2022] Open
Abstract
Background Hymenoptera sting reactions are among life-threatening causes of allergy. Several epidemiology studies have assessed the risk of these kind of reactions, among the general population, around 3% of adults. This incidence increases among highly at risk populations such as outdoor workers. Hymenoptera stings among forestry workers (FW) are occupational triggers but it has not yet been well defined which is the real incidence of anaphylaxis in these workers, not even in Italy. Two Italian studies reported on the risk of hymenoptera stings (HS) in northern Italy (NI) and central Italy (CI) FW while no data is available on the prevalence in southern Italy (SI) ones. Methods A population of 341 SI FW (301 males and 40 females, mean age 51 years, range 43-63 years), who worked in Sicily, was investigated submitting a standardized questionnaire dealing with reactions to Hymenoptera stings, such as large local reactions (LLR) and systemic reactions (SR). Results HS occurred in 203 FW (59%) and caused reactions in 77 (22%); LLR occurred in 46 (13%) and SR in 31 (9%); SR were life threatening in 9/341 (3%) FW and were treated with epinephrine at the emergency unit as workers did not carry an epinephrine auto-injector. A SR at a subsequent HS followed a LLR in 21/46 FW (46%). Conclusions FW in SI have a generic risk of HS anaphylaxis as in the general population but a higher risk of SR and LLR respect to forestry populations from different Italian geographical areas.SR among SI FW occurred in 9% of them, while published data report the incidence of SR around 2 and 4%, respectively, in the Centre and North Italy FW. The incidence of LLR in SI FW was also higher (13%) than in CI (2%) and NI (10%) ones. Previous LLR in our SI population represented a high risk factor for developing a SR and therefore a red flag for future anaphylaxis and prescription of an epinephrine auto-injector.
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Affiliation(s)
- Luisa Ricciardi
- 1Department of Clinical and Experimental Medicine, School and Division of Allergy and Clinical Immunology, University of Messina, Messina, Italy
| | - Francesco Papia
- 1Department of Clinical and Experimental Medicine, School and Division of Allergy and Clinical Immunology, University of Messina, Messina, Italy
| | - Giuseppe Cataldo
- 1Department of Clinical and Experimental Medicine, School and Division of Allergy and Clinical Immunology, University of Messina, Messina, Italy
| | - Mario Giorgianni
- 2Department of Biomedical Sciences, Dental, Morphological and Functional Investigations, University of Messina, Messina, Italy
| | - Giovanna Spatari
- 2Department of Biomedical Sciences, Dental, Morphological and Functional Investigations, University of Messina, Messina, Italy
| | - Sebastiano Gangemi
- 1Department of Clinical and Experimental Medicine, School and Division of Allergy and Clinical Immunology, University of Messina, Messina, Italy
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Abstract
Abstract. Risk factors should be part of the decision, of which patient should be offered venom immunotherapy (VIT) and how VIT should be performed. Risk factors for a severe systemic anaphylactic reaction (SAR) after a Hymenoptera field sting include a preceding less severe sting reaction, a wasp sting, an increased baseline serum tryptase concentration (BSTC), mastocytosis, older age, ACE inhibitor medication, and male gender. During VIT, treatment with honey bee venom is the most important risk factor for a SAR. Further risk factors include a high BSTC (for vespid VIT only), presence of venom specific IgE in serum, any antihypertensive medication during therapy, and an ultra-rush protocol for build-up. Treatment failure is more common in patients suffering from honey bee venom allergy, high BSTC (for vespid VIT only) or mastocytosis, and in those who had experienced side effects during VIT. Besides discontinuing antihypertensive medication or switching to a moderate type of dose increase during build-up, little can be done to minimize the risks associated with VIT. Increasing the maintenance dose may improve the efficacy of VIT. In patients with a particularly high risk for treatment failure, or in case of treatment failure, VIT should include an increased maintenance dose right from the beginning. Usually, 200 µg will be sufficient.
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29
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Canillas F. Pieter Bruegel the Elder. The Beekeepers and the Birdnester c.1568. Occup Med (Lond) 2017. [DOI: 10.1093/occmed/kqx060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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30
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Bienengiftallergie — im Trend bei Hobby-Imkern. ALLERGO JOURNAL 2017. [DOI: 10.1007/s15007-017-1366-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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31
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Hirata H, Tatewaki M, Shiromori S, Ikeno Y, Akutsu I, Sugiyama K, Arima M, Kurasawa K, Fukuda T, Shima D, Fukushima Y. Specific IgE sensitization to honey bee venom and auto-injector adrenaline prescriptions for Japanese beekeepers. Allergol Int 2017; 66:149-151. [PMID: 27516131 DOI: 10.1016/j.alit.2016.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/24/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022] Open
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32
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Aoki V, Rivitti EA, Diaz LA. Update on fogo selvagem, an endemic form of pemphigus foliaceus. J Dermatol 2016; 42:18-26. [PMID: 25558948 DOI: 10.1111/1346-8138.12675] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 09/17/2014] [Indexed: 12/26/2022]
Abstract
Pemphigus are organ-specific autoimmune diseases, where autoantibodies (mainly immunoglobulin [Ig]G) directed against epidermal targets (glycoproteins of the desmosomal core) are detected. Endemic pemphigus foliaceus or fogo selvagem (FS) is one of the variants of pemphigus foliaceus pemphigus foliaceus that shares the same clinical and immunopathological features of the classic non-endemic pemphigus foliaceus form, including pathogenic IgG (mainly IgG4) autoantibodies directed against the ectodomain of desmoglein 1 (Dsg1), that lead to acantholysis. Pathogenesis of FS is complex, involving genetic, environmental and immunological factors. Human leukocyte antigen (HLA)-DRB1 alleles DRB1*0404, *1402, *1406 or *0102 have been previously identified as risk factors for FS (relative risk, >14). Individuals exposed to hematophagous insects are more susceptible to develop the disease. Non-pathogenic anti-Dsg1 antibodies of the IgG1 subclass, directed against the extracellular 5 domain of Dsg1, are detected in patients in the preclinical stage of the disease, and also in healthy controls living in endemic areas. In counterpart, patients with FS show pathogenic anti-Dsg1 IgG4 autoantibodies that bind the pathogenic extracellular 1 and 2 domains of Dsg1, emphasizing the intramolecular epitope-spreading hypothesis. A possible explanation for the development of the autoimmune process would be antigenic mimicry, initiated by environmental stimuli in those genetically predisposed individuals. Characterization of the pathogenesis of FS will allow the development of specific therapeutic targets, and the elucidation of other autoimmune processes.
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Affiliation(s)
- Valeria Aoki
- Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
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Galli SJ. The Mast Cell-IgE Paradox: From Homeostasis to Anaphylaxis. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 186:212-24. [PMID: 26776074 DOI: 10.1016/j.ajpath.2015.07.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/23/2015] [Accepted: 07/30/2015] [Indexed: 12/20/2022]
Abstract
Mast cells and IgE are so inextricably linked to the pathology of allergic disorders, including fatal anaphylaxis, that it can be difficult to think of them in other contexts. Surely, we do not have mast cells and IgE so that we can eat a peanut and die! It is thought that mast cells and IgE and basophils (circulating granulocytes, whose functions partially overlap with those of mast cells) can contribute to host defense as components of adaptive T helper cell type 2 immune responses to helminths, ticks, and certain other parasites. Accordingly, it was suggested that allergies are misdirected type 2 immune responses in which IgE antibodies are produced against any of a broad variety of apparently harmless antigens. However, components of animal venoms also can sensitize individuals to develop severe IgE-associated allergic reactions, including fatal anaphylaxis, on subsequent venom exposure. Here, I describe evidence that mast cells can enhance innate host resistance to reptile or arthropod venoms during responses to an initial exposure to such venoms and that acquired type 2 immune responses, IgE antibodies, the high-affinity IgE receptor FcεRI, and mast cells can contribute toward acquired resistance in mice to the lethal effects of honeybee or Russell's viper venom. These findings support the hypothesis that mast cells and IgE can help protect the host against noxious substances.
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Affiliation(s)
- Stephen J Galli
- Department of Pathology, Stanford University School of Medicine, Stanford, California; Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California; Sean N. Parker Center for Allergy Research, Stanford University School of Medicine, Stanford, California.
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Krovi SH, Gapin L. It is time to beelieve the CD1a hype! Eur J Immunol 2016; 46:56-9. [PMID: 26617406 DOI: 10.1002/eji.201546157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 11/12/2015] [Accepted: 11/25/2015] [Indexed: 11/07/2022]
Abstract
Conventional T cells have historically been linked to exacerbating allergy. By efficiently generating primarily TH 2 cells, allergens skew the immune response to produce IL-4, IL-13, and IgE. Previously, CD1a-responsive T cells were shown to functionally respond to bee and wasp venom allergens. In this issue of the European Journal of Immunology, Subramaniam et al. [Eur. J. Immunol. 2016. 46: 242-252] show that more functionally active CD1a-restricted cells are present in bee venom-allergic patients than in healthy patients. Additionally, the authors show that these cells are not as frequently found in individuals receiving venom immunotherapy. Consequently, this study implicates CD1a-reactive cells as the primary responders to venom allergy, which considerably regulate the downstream immune response.
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Affiliation(s)
- Sai Harsha Krovi
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical, Campus, Aurora, CO, USA
| | - Laurent Gapin
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical, Campus, Aurora, CO, USA
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35
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Mukai K, Tsai M, Starkl P, Marichal T, Galli SJ. IgE and mast cells in host defense against parasites and venoms. Semin Immunopathol 2016; 38:581-603. [PMID: 27225312 DOI: 10.1007/s00281-016-0565-1] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/26/2016] [Indexed: 12/12/2022]
Abstract
IgE-dependent mast cell activation is a major effector mechanism underlying the pathology associated with allergic disorders. The most dramatic of these IgE-associated disorders is the fatal anaphylaxis which can occur in some people who have developed IgE antibodies to otherwise innocuous antigens, such as those contained in certain foods and medicines. Why would such a highly "maladaptive" immune response develop in evolution and be retained to the present day? Host defense against parasites has long been considered the only beneficial function that might be conferred by IgE and mast cells. However, recent studies have provided evidence that, in addition to participating in host resistance to certain parasites, mast cells and IgE are critical components of innate (mast cells) and adaptive (mast cells and IgE) immune responses that can enhance host defense against the toxicity of certain arthropod and animal venoms, including enhancing the survival of mice injected with such venoms. Yet, in some people, developing IgE antibodies to insect or snake venoms puts them at risk for having a potentially fatal anaphylactic reaction upon subsequent exposure to such venoms. Delineating the mechanisms underlying beneficial versus detrimental innate and adaptive immune responses associated with mast cell activation and IgE is likely to enhance our ability to identify potential therapeutic targets in such settings, not only for reducing the pathology associated with allergic disorders but perhaps also for enhancing immune protection against pathogens and animal venoms.
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Affiliation(s)
- Kaori Mukai
- Department of Pathology, Stanford University School of Medicine, Stanford, California 94305-5324, USA.,Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California 94305-5324, USA
| | - Mindy Tsai
- Department of Pathology, Stanford University School of Medicine, Stanford, California 94305-5324, USA.,Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California 94305-5324, USA
| | - Philipp Starkl
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, and Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Marichal
- Laboratory of Cellular and Molecular Immunology, GIGA-Research and Faculty of Veterinary Medicine, University of Liège, 4000 Liège, Belgium
| | - Stephen J Galli
- Department of Pathology, Stanford University School of Medicine, Stanford, California 94305-5324, USA.,Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, California 94305-5324, USA.,Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California 94305-5324, USA
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Galli SJ, Starkl P, Marichal T, Tsai M. Mast cells and IgE in defense against venoms: Possible "good side" of allergy? Allergol Int 2016; 65:3-15. [PMID: 26666482 DOI: 10.1016/j.alit.2015.09.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/03/2015] [Indexed: 01/05/2023] Open
Abstract
Physicians think of mast cells and IgE primarily in the context of allergic disorders, including fatal anaphylaxis. This 'bad side' of mast cells and IgE is so well accepted that it can be difficult to think of them in other contexts, particularly those in which they may have beneficial functions. However, there is evidence that mast cells and IgE, as well as basophils (circulating granulocytes whose functions partially overlap with those of mast cells), can contribute to host defense as components of adaptive type 2 immune responses to helminths, ticks and certain other parasites. Accordingly, allergies often are conceptualized as "misdirected" type 2 immune responses, in which IgE antibodies are produced against any of a diverse group of apparently harmless antigens, as well as against components of animal venoms. Indeed, certain unfortunate patients who have become sensitized to venoms develop severe IgE-associated allergic reactions, including fatal anaphylaxis, upon subsequent venom exposure. In this review, we will describe evidence that mast cells can enhance innate resistance to reptile or arthropod venoms during a first exposure to such venoms. We also will discuss findings indicating that, in mice which survive an initial encounter with venom, acquired type 2 immune responses, IgE antibodies, the high affinity IgE receptor (FcɛRI), and mast cells can contribute to acquired resistance to the lethal effects of both honeybee venom and Russell's viper venom. These findings support the hypothesis that mast cells and IgE can help protect the host against venoms and perhaps other noxious substances.
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Affiliation(s)
- Stephen J Galli
- Department of Pathology and the Sean N. Parker Center for Allergy Research, Stanford University School of Medicine, Stanford, CA, USA; Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Philipp Starkl
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria; Department of Medicine 1, Laboratory of Infection Biology, Medical University of Vienna, Vienna, Austria
| | - Thomas Marichal
- GIGA-Research and Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Mindy Tsai
- Department of Pathology and the Sean N. Parker Center for Allergy Research, Stanford University School of Medicine, Stanford, CA, USA
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Bioley G, Lassus A, Terrettaz J, Tranquart F, Corthésy B. Prophylactic immunization of mice with phospholipase A2-loaded gas-filled microbubbles is protective against Th2-mediated honeybee venom allergy. Clin Exp Allergy 2015; 46:153-62. [DOI: 10.1111/cea.12555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/24/2015] [Accepted: 04/06/2015] [Indexed: 12/28/2022]
Affiliation(s)
- G. Bioley
- R&D Laboratory; Division of Immunology and Allergy; University State Hospital (CHUV); Epalinges Switzerland
| | - A. Lassus
- Bracco Suisse SA; Plan-Les-Ouates Switzerland
| | | | | | - B. Corthésy
- R&D Laboratory; Division of Immunology and Allergy; University State Hospital (CHUV); Epalinges Switzerland
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Starkl P, Marichal T, Gaudenzio N, Reber LL, Sibilano R, Tsai M, Galli SJ. IgE antibodies, FcεRIα, and IgE-mediated local anaphylaxis can limit snake venom toxicity. J Allergy Clin Immunol 2015; 137:246-257.e11. [PMID: 26410782 DOI: 10.1016/j.jaci.2015.08.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 06/25/2015] [Accepted: 08/05/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Type 2 cytokine-related immune responses associated with development of antigen-specific IgE antibodies can contribute to pathology in patients with allergic diseases and to fatal anaphylaxis. However, recent findings in mice indicate that IgE also can enhance defense against honeybee venom. OBJECTIVE We tested whether IgE antibodies, IgE-dependent effector mechanisms, and a local anaphylactic reaction to an unrelated antigen can enhance defense against Russell viper venom (RVV) and determined whether such responses can be influenced by immunization protocol or mouse strain. METHODS We compared the resistance of RVV-immunized wild-type, IgE-deficient, and Fcer1a-deficient mice after injection of a potentially lethal dose of RVV. RESULTS A single prior exposure to RVV enhanced the ability of wild-type mice, but not mice lacking IgE or functional FcεRI, to survive challenge with a potentially lethal amount of RVV. Moreover, IgE-dependent local passive cutaneous anaphylaxis in response to challenge with an antigen not naturally present in RVV significantly enhanced resistance to the venom. Finally, we observed different effects on resistance to RVV or honeybee venom in BALB/c versus C57BL/6 mice that had received a second exposure to that venom before challenge with a high dose of that venom. CONCLUSION These observations illustrate the potential benefit of IgE-dependent effector mechanisms in acquired host defense against venoms. The extent to which type 2 immune responses against venoms can decrease pathology associated with envenomation seems to be influenced by the type of venom, the frequency of venom exposure, and the genetic background of the host.
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Affiliation(s)
- Philipp Starkl
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Thomas Marichal
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Nicolas Gaudenzio
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Laurent Lionel Reber
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Riccardo Sibilano
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Mindy Tsai
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Stephen Joseph Galli
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, Calif.
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Tsai M, Starkl P, Marichal T, Galli SJ. Testing the 'toxin hypothesis of allergy': mast cells, IgE, and innate and acquired immune responses to venoms. Curr Opin Immunol 2015. [PMID: 26210895 DOI: 10.1016/j.coi.2015.07.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Work in mice indicates that innate functions of mast cells, particularly degradation of venom toxins by mast cell-derived proteases, can enhance resistance to certain arthropod or reptile venoms. Recent reports indicate that acquired Th2 immune responses associated with the production of IgE antibodies, induced by Russell's viper venom or honeybee venom, or by a component of honeybee venom, bee venom phospholipase 2 (bvPLA2), can increase the resistance of mice to challenge with potentially lethal doses of either of the venoms or bvPLA2. These findings support the conclusion that, in contrast to the detrimental effects associated with allergic type 2 (Th2) immune responses, mast cells and IgE-dependent immune responses to venoms can contribute to innate and adaptive resistance to venom-induced pathology and mortality.
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Affiliation(s)
- Mindy Tsai
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Philipp Starkl
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Thomas Marichal
- GIGA-Research and Faculty of Veterinary Medicine, University of Liege, 4000 Liege, Belgium
| | - Stephen J Galli
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Ittyachen AM, Abdulla S, Anwarsha RF, Kumar BS. Multi-organ dysfunction secondary to severe wasp envenomation. Int J Emerg Med 2015; 8:6. [PMID: 25852776 PMCID: PMC4385238 DOI: 10.1186/s12245-015-0054-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/17/2015] [Indexed: 11/10/2022] Open
Abstract
Wasp sting is not an uncommon incident. Around 56% to 94% of the population is stung at least once in their lifetime by a member of the order Hymenoptera which includes wasps, bees, and ants. The response to a wasp sting may vary from mild local reaction to severe systemic and anaphylactic reactions. The clinical picture and mortality rate tend to be more severe in adults compared to children. We present a 32-year-old agricultural worker who was bitten by multiple wasps while on a coconut tree. In spite of the heavy load of venom due to the multiple bites, the patient did not develop anaphylaxis. However, a delayed reaction did occur within 48 h in the form of severe multi-organ dysfunction. There was significant improvement by around 2 weeks; but it took another 6 months for the serum creatinine to normalize. This case highlights the occupational risk of Hymenoptera envenomation, the life-threatening complications that may follow and which may even be delayed as was the case with this patient, and the value of emergency care and intensive management which can result in a favorable clinical outcome.
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Affiliation(s)
- Abraham M Ittyachen
- Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala State 682311 India
| | - Shanavas Abdulla
- Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala State 682311 India
| | - Rifzana Fathima Anwarsha
- Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala State 682311 India
| | - Bhavya S Kumar
- Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala State 682311 India
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Ruiz B, Serrano P, Verdú M, Moreno C. Sensitization to Api m 1, Api m 2, and Api m 4: association with safety of bee venom immunotherapy. Ann Allergy Asthma Immunol 2015; 114:350-2. [PMID: 25736542 DOI: 10.1016/j.anai.2015.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 01/20/2015] [Accepted: 01/21/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Berta Ruiz
- Department of Allergology, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain.
| | - Pilar Serrano
- Department of Allergology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Miriam Verdú
- Department of Allergology, Hospital Universitario de Ceuta, Ceuta, Spain
| | - Carmen Moreno
- Department of Allergology, Hospital Universitario Reina Sofía, Córdoba, Spain
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Siracusa A, Folletti I, Gerth van Wijk R, Jeebhay MF, Moscato G, Quirce S, Raulf M, Ruëff F, Walusiak-Skorupa J, Whitaker P, Tarlo SM. Occupational anaphylaxis--an EAACI task force consensus statement. Allergy 2015; 70:141-52. [PMID: 25369880 DOI: 10.1111/all.12541] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 12/26/2022]
Abstract
Anaphylaxis is a systemic allergic reaction, potentially life-threatening that can be due to nonoccupational or, less commonly, to occupational triggers. Occupational anaphylaxis (OcAn) could be defined as anaphylaxis arising out of triggers and conditions attributable to a particular work environment. Hymenoptera stings and natural rubber latex are the commonest triggers of OcAn. Other triggers include food, medications, insect/mammal/snake bites, and chemicals. The underlying mechanisms of anaphylactic reactions due to occupational exposure are usually IgE-mediated and less frequently non-IgE-mediated allergy or nonallergic. Some aspects of work-related allergen exposure, such as route and frequency of exposure, type of allergens, and cofactors may explain the variability of symptoms in contrast to the nonoccupational setting. When assessing OcAn, both confirmation of the diagnosis of anaphylactic reaction and identification of the trigger are required. Prevention of further episodes is important and is based on removal from further exposure. Workers with a history of OcAn should immediately be provided with a written emergency management plan and an adrenaline auto-injector and educated to its use. Immunotherapy is recommended only for OcAn due to Hymenoptera stings.
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Affiliation(s)
- A. Siracusa
- Formerly professor of Occupational Medicine; University of Perugia; Perugia Italy
| | - I. Folletti
- Occupational Medicine; Terni Hospital; University of Perugia; Perugia Italy
| | - R. Gerth van Wijk
- Section of Allergology; Department of Internal Medicine; Erasmus Medical Center; Rotterdam the Netherlands
| | - M. F. Jeebhay
- Centre for Occupational and Environmental Health Research; School of Public Health and Family Medicine; University of Cape Town; Cape Town South Africa
| | - G. Moscato
- Department of Public Health; Experimental and Forensic Medicine of the University of Pavia; Pavia Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPAZ) and CIBER of Respiratory Diseases CIBERES; Madrid Spain
| | - M. Raulf
- Institute of Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr University Bochum; Bochum Germany
| | - F. Ruëff
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | | | - P. Whitaker
- Department of Respiratory Medicine; Leeds Teaching Hospitals NHS Trust; Leeds UK
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Van Vaerenbergh M, De Smet L, Rafei-Shamsabadi D, Blank S, Spillner E, Ebo DG, Devreese B, Jakob T, de Graaf DC. IgE recognition of chimeric isoforms of the honeybee (Apis mellifera) venom allergen Api m 10 evaluated by protein array technology. Mol Immunol 2014; 63:449-55. [PMID: 25451974 DOI: 10.1016/j.molimm.2014.09.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 09/28/2014] [Indexed: 11/18/2022]
Abstract
Api m 10 has recently been established as novel major allergen that is recognized by more than 60% of honeybee venom (HBV) allergic patients. Previous studies suggest Api m 10 protein heterogeneity which may have implications for diagnosis and immunotherapy of HBV allergy. In the present study, RT-PCR revealed the expression of at least nine additional Api m 10 transcript isoforms by the venom glands. Two distinct mechanisms are responsible for the generation of these isoforms: while the previously known variant 2 is produced by an alternative splicing event, novel identified isoforms are intragenic chimeric transcripts. To the best of our knowledge, this is the first report of the identification of chimeric transcripts generated by the honeybee. By a retrospective proteomic analysis we found evidence for the presence of several of these isoforms in the venom proteome. Additionally, we analyzed IgE reactivity to different isoforms by protein array technology using sera from HBV allergic patients, which revealed that IgE recognition of Api m 10 is both isoform- and patient-specific. While it was previously demonstrated that the majority of HBV allergic patients display IgE reactivity to variant 2, our study also shows that some patients lacking IgE antibodies for variant 2 display IgE reactivity to two of the novel identified Api m 10 variants, i.e. variants 3 and 4.
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Affiliation(s)
- Matthias Van Vaerenbergh
- Laboratory of Molecular Entomology and Bee Pathology, Ghent University, Krijgslaan 281 S2, B-9000 Ghent, Belgium
| | - Lina De Smet
- Laboratory of Molecular Entomology and Bee Pathology, Ghent University, Krijgslaan 281 S2, B-9000 Ghent, Belgium
| | - David Rafei-Shamsabadi
- Allergy Research Group, Department of Dermatology, University Medical Center Freiburg, Hauptstrasse 7, D-79104 Freiburg, Germany
| | - Simon Blank
- Center of Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Ingolstädter Landstraße 1, D-85764 Munich, Germany
| | - Edzard Spillner
- Department of Engineering, Aarhus University, Gustav Wieds Vej 10, DK-8000 Aarhus C, Denmark
| | - Didier G Ebo
- Department of Immunology, Allergology, and Rheumatology, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium
| | - Bart Devreese
- Laboratory of Protein Biochemistry and Biomolecular Engineering, Ghent University, K.L. Ledeganckstraat 35, B-9000 Ghent, Belgium
| | - Thilo Jakob
- Allergy Research Group, Department of Dermatology, University Medical Center Freiburg, Hauptstrasse 7, D-79104 Freiburg, Germany
| | - Dirk C de Graaf
- Laboratory of Molecular Entomology and Bee Pathology, Ghent University, Krijgslaan 281 S2, B-9000 Ghent, Belgium.
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IgE anti-LJM11 sand fly salivary antigen may herald the onset of fogo selvagem in endemic Brazilian regions. J Invest Dermatol 2014; 135:913-915. [PMID: 25285921 PMCID: PMC4323842 DOI: 10.1038/jid.2014.430] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Çelıksoy MH, Sancak R, Söğüt A, Güner SN, Korkmaz A. Characteristics of venom allergic reactions in Turkish beekeepers and alternative treatment modalities. Int Forum Allergy Rhinol 2014; 4:555-8. [PMID: 24668848 DOI: 10.1002/alr.21314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/28/2014] [Accepted: 02/03/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND The objective of this work was to determine the characteristics of allergic reactions that may occur after a bee sting and alternative treatment methods in Turkish beekeepers. METHODS A written questionnaire was administered to beekeepers from the Ordu, Samsun, Sinop, Amasya, and Çorum provinces located in the Central Black Sea Region of Turkey. RESULTS The study included 301 beekeepers, 295 (98%) of whom were male. Their mean age was 48.2 ± 11.5 years. The mean beekeeping duration was 15.3 ± 10.5 years. A total of 270 participants (89.9%) had a history of bee stings in the previous 12 months. Systemic reactions, large local reactions, and local reactions were seen in 21 (6.9%), 193 (64.1%), and 12 (4.0%) beekeepers, respectively. The face was the most frequently stung body site, and swelling generally occurred in the eyelids. The size of the swellings decreased within 12 to 24 hours in 259 (86.1%) beekeepers. The size of the swellings was 1 × 2 cm in diameter in 157 (52.2%) beekeepers. Natural protection against bee stings had developed by 12 months in 140 (46.5%) beekeepers. In total, 61.5% of the beekeepers applied alternative treatments (eg, garlic, onion water, yogurt), whereas 14.0% (3/21) were admitted to a hospital with a systemic reaction. In total, 10.6% and 14.2% of beekeepers were aware of adrenaline auto-injector and venom immunotherapy, respectively. CONCLUSION This study indicates insufficient knowledge and attitudes among Turkish beekeepers regarding bee sting reactions.
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Affiliation(s)
- Mehmet Halil Çelıksoy
- Ondokuz Mayıs University, Faculty of Medicine, Department of Pediatric Allergy and Immunology, Samsun, Turkey
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Köhler J, Blank S, Müller S, Bantleon F, Frick M, Huss-Marp J, Lidholm J, Spillner E, Jakob T. Component resolution reveals additional major allergens in patients with honeybee venom allergy. J Allergy Clin Immunol 2014; 133:1383-9, 1389.e1-6. [PMID: 24440283 DOI: 10.1016/j.jaci.2013.10.060] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 09/21/2013] [Accepted: 10/17/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Detection of IgE to recombinant Hymenoptera venom allergens has been suggested to improve the diagnostic precision in Hymenoptera venom allergy. However, the frequency of sensitization to the only available recombinant honeybee venom (HBV) allergen, rApi m 1, in patients with HBV allergy is limited, suggesting that additional HBV allergens might be of relevance. OBJECTIVE We performed an analysis of sensitization profiles of patients with HBV allergy to a panel of HBV allergens. METHODS Diagnosis of HBV allergy (n = 144) was based on history, skin test results, and allergen-specific IgE levels to HBV. IgE reactivity to 6 HBV allergens devoid of cross-reactive carbohydrate determinants (CCD) was analyzed by ImmunoCAP. RESULTS IgE reactivity to rApi m 1, rApi m 2, rApi m 3, nApi m 4, rApi m 5, and rApi m 10 was detected in 72.2%, 47.9%, 50.0%, 22.9%, 58.3%, and 61.8% of the patients with HBV allergy, respectively. Positive results to at least 1 HBV allergen were detected in 94.4%. IgE reactivity to Api m 3, Api m 10, or both was detected in 68.0% and represented the only HBV allergen-specific IgE in 5% of the patients. Limited inhibition of IgE binding by therapeutic HBV and limited induction of Api m 3- and Api m 10-specific IgG4 in patients obtaining immunotherapy supports recent reports on the underrepresentation of these allergens in therapeutic HBV preparations. CONCLUSION Analysis of a panel of CCD-free HBV allergens improved diagnostic sensitivity compared with use of rApi m 1 alone, identified additional major allergens, and revealed sensitizations to allergens that have been reported to be absent or underrepresented in therapeutic HBV preparations.
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Affiliation(s)
- Julian Köhler
- Allergy Research Group, Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany
| | - Simon Blank
- Institute of Biochemistry and Molecular Biology, University of Hamburg, Hamburg, Germany
| | - Sabine Müller
- Allergy Research Group, Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany
| | - Frank Bantleon
- Institute of Biochemistry and Molecular Biology, University of Hamburg, Hamburg, Germany
| | - Marcel Frick
- Allergy Research Group, Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany
| | - Johannes Huss-Marp
- Allergy Research Group, Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany; Thermo Fisher Scientific, Freiburg, Germany
| | | | - Edzard Spillner
- Institute of Biochemistry and Molecular Biology, University of Hamburg, Hamburg, Germany.
| | - Thilo Jakob
- Allergy Research Group, Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany.
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Hayashih Y, Hirata H, Watanabe M, Yoshida N, Yokoyama T, Murayama Y, Sugiyama K, Arima M, Fukushima Y, Fukuda T, Ishii Y. Epidemiologic Investigation of Hornet and Paper Wasp Stings in Forest Workers and Electrical Facility Field Workers in Japan. Allergol Int 2014; 63:21-26. [DOI: 10.2332/allergolint.13-oa-0556] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 07/17/2013] [Indexed: 11/20/2022] Open
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Marichal T, Starkl P, Reber LL, Kalesnikoff J, Oettgen HC, Tsai M, Metz M, Galli SJ. A beneficial role for immunoglobulin E in host defense against honeybee venom. Immunity 2013; 39:963-75. [PMID: 24210352 PMCID: PMC4164235 DOI: 10.1016/j.immuni.2013.10.005] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 08/21/2013] [Indexed: 10/26/2022]
Abstract
Allergies are widely considered to be misdirected type 2 immune responses, in which immunoglobulin E (IgE) antibodies are produced against any of a broad range of seemingly harmless antigens. However, components of insect venoms also can sensitize individuals to develop severe IgE-associated allergic reactions, including fatal anaphylaxis, upon subsequent venom exposure. We found that mice injected with amounts of honeybee venom similar to that which could be delivered in one or two stings developed a specific type 2 immune response that increased their resistance to subsequent challenge with potentially lethal amounts of the venom. Our data indicate that IgE antibodies and the high affinity IgE receptor, FcεRI, were essential for such acquired resistance to honeybee venom. The evidence that IgE-dependent immune responses against venom can enhance survival in mice supports the hypothesis that IgE, which also contributes to allergic disorders, has an important function in protection of the host against noxious substances.
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Affiliation(s)
- Thomas Marichal
- Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305; USA
| | - Philipp Starkl
- Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305; USA
| | - Laurent L. Reber
- Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305; USA
| | - Janet Kalesnikoff
- Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305; USA
| | - Hans C. Oettgen
- Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, California, 94305; USA
| | - Mindy Tsai
- Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305; USA
| | - Martin Metz
- Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305; USA
- Division of Immunology, Boston Children’s Hospital, Boston, Massachusetts, 02115; USA
| | - Stephen J. Galli
- Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305; USA
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Bilò MB, Antonicelli L, Bonifazi F. Honeybee venom immunotherapy: certainties and pitfalls. Immunotherapy 2013. [PMID: 23194365 DOI: 10.2217/imt.12.113] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- M Beatrice Bilò
- Allergy Unit, Department of Immunology, Allergy & Respiratory Diseases, University Hospital Ospedali Riuniti di Ancona, Ancona, Italy.
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