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Möbs C, Wiedemann D, Pfützner W. Evaluation of a modified skin prick test for diagnosis of Hymenoptera venom allergy. ALLERGO JOURNAL 2019. [DOI: 10.1007/s15007-019-1807-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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Khurana T, Bridgewater JL, Rabin RL. Allergenic extracts to diagnose and treat sensitivity to insect venoms and inhaled allergens. Ann Allergy Asthma Immunol 2017; 118:531-536. [PMID: 28477785 DOI: 10.1016/j.anai.2016.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/18/2016] [Accepted: 05/31/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To review allergenic extracts used to diagnose or treat insect allergies, including how the extracts are manufactured and their measurements of potency or concentration. DATA SOURCES Peer-reviewed articles derived from searching PubMed (National Center for Biotechnology Information) about insect allergies and extract preparation. Encyclopedia of Life (http://www.eol.org/) and http://allergome.org/ were also referenced for background information on insects and associated allergens. STUDY SELECTIONS Search terms used for the PubMed searches included insect allergens and allergies, Apidae, Vespidae, fire ants, cockroach allergies, insect allergen extract preparation, and standardization. RESULTS Humans may be sensitized to insect allergens by inhalation or through stings. Cockroaches and moths are predominantly responsible for inhalation insect allergy and are a major indoor allergen in urban settings. Bees, fire ants, and wasps are responsible for sting allergy. In the United States, there are multiple insect allergen products commercially available that are regulated by the US Food and Drug Administration. Of those extracts, honeybee venom and insect venom proteins are standardized with measurements of potency. The remaining insect allergen extracts are nonstandardized products that do not have potency measurements. CONCLUSION Sensitization to inhalational and stinging insect allergens is reported worldwide. Crude insect allergen extracts are used for diagnosis and specific immunotherapy. A variety of source materials are used by different manufacturers to prepare these extracts, which may result in qualitative differences that are not reflected in measurements of potency or protein concentration.
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Affiliation(s)
- Taruna Khurana
- Division of Vaccines and Related Products Applications, US Food and Drug Administration, Silver Spring, Maryland
| | - Jennifer L Bridgewater
- Division of Bacterial, Parasitic and Allergenic Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Ronald L Rabin
- Division of Bacterial, Parasitic and Allergenic Products, US Food and Drug Administration, Silver Spring, Maryland.
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Urra JM, Cabrera CM, Alfaya T, Feo-Brito F. Agreement of skin test with IL-4 production and CD40L expression by T cells upon immunotherapy of subjects with systemic reactions to Hymenoptera stings. Mol Immunol 2016; 70:134-9. [PMID: 26774053 DOI: 10.1016/j.molimm.2015.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 12/16/2015] [Accepted: 12/19/2015] [Indexed: 10/22/2022]
Abstract
Venom immunotherapy is the only curative intervention for subjects with Hymenoptera venom allergy who suffering systemic reactions upon bee or wasp stings. Venom immunotherapy can restore normal immunity against venom allergens, as well as providing to allergic subjects a lifetime tolerance against venoms. Nevertheless, it is necessary using safety assays to monitoring the development of tolerance in the VIT protocols to avoid fatal anaphylactic reactions. The purpose of this study was to assess the modifications in several markers of tolerance induction in subjects with Hymenoptera venom allergy undergoing immunotherapy. The studies were performed at baseline time and after six month of VIT. Intradermal skin tests, basophil activation tests, specific IgE levels; and the T-cell markers (IL-4 and IFN-γ producing cells; and expression of the surface activation markers CD40L and CTLA-4) were assayed. At six month of immunotherapy all parameters studied had significant alterations. All decreased, except the IFN-γ producing cells. In addition, modifications in intradermal skin test showed a significant correlation with both, CD40L expression on CD4 T lymphocytes (p=0.043) and IL-4 producing T lymphocytes (p=0.012). Neither basophil activation test nor serum levels of sIgE demonstrated any correlation with the immunological parameters studied nor among them. These results suggest that both IL-4 production and CD40L expression could be two good indicators of the beneficial effects of venom immunotherapy which translate into skin tests.
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Affiliation(s)
- José M Urra
- Immunology Section, Hospital General Universitario de Ciudad Real, Spain; Medical Faculty of Ciudad Real, University of Castilla La Mancha, Spain.
| | | | - Teresa Alfaya
- Alergology Section, Hospital General Universitario de Ciudad Real, Spain
| | - Francisco Feo-Brito
- Alergology Section, Hospital General Universitario de Ciudad Real, Spain; Medical Faculty of Ciudad Real, University of Castilla La Mancha, Spain
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In SH, Shin YC, Hwang EK, You HW, Kim JIL, Park JH, Jang AS. Unusual reaction to Hymenoptera stings. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.4.305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Suk-Hwan In
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Young-Cheol Shin
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eui-Kwon Hwang
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hae-Won You
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jun-IL Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - June-Hyuck Park
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - An-Soo Jang
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Pravettoni V, Piantanida M, Primavesi L, Forti S, Pastorello EA. Determinants of venom-specific IgE antibody concentration during long-term wasp venom immunotherapy. Clin Mol Allergy 2015; 13:29. [PMID: 26674806 PMCID: PMC4678606 DOI: 10.1186/s12948-015-0036-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background Venom immunotherapy (VIT) is an effective treatment for subjects with systemic allergic reactions (SR) to Hymenoptera stings, however there are few studies concerning the relevance of the venom specific IgE changes to decide about VIT cessation. We assessed IgE changes during a 5-year VIT, in patients stung and protected within the first 3 years (SP 0–3) or in the last 2 years (SP 3–5), and in patients not stung (NoS), to evaluate possible correlations between IgE changes and clinical protection. Methods Yellow jacket venom (YJV)-allergic patients who completed 5 years of VIT were retrospectively evaluated. Baseline IgE levels and after the 3rd and the 5th year of VIT were determined; all patients were asked about field stings and SRs. Results A total of 232 YJV-allergic patients were included and divided into the following groups: 84 NoS, 72 SP 0–3 and 76 SP 3–5. IgE levels decreased during VIT compared to baseline values (χ2 = 346.029, p < 0.001). Recent vespid stings accounted for significantly higher IgE levels despite clinical protection. IgE levels after 5 years of VIT correlated significantly with Mueller grade (F = 2.778, p = 0.012) and age (F = 6.672, p = 0.002). During follow-up from 1 to 10 years after VIT discontinuation, 35.2 % of the contacted patients reported at least one field sting without SR. Conclusions The yellow jacket-VIT temporal stopping criterion of 5 years duration did not result in undetectable IgE levels, despite a long-lasting protection. A mean IgE decrease from 58 to 70 % was observed, and it was less marked in elderly patients or in subjects with higher Mueller grade SR.
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Affiliation(s)
- Valerio Pravettoni
- Clinical Allergy and Immunology Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Piantanida
- Clinical Allergy and Immunology Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Primavesi
- Clinical Allergy and Immunology Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stella Forti
- Unit of Audiology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Elide A Pastorello
- Unit of Allergology and Immunology, Niguarda Ca' Granda Hospital, Milan, Italy
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Ruëff F, Vos B, Oude Elberink J, Bender A, Chatelain R, Dugas-Breit S, Horny HP, Küchenhoff H, Linhardt A, Mastnik S, Sotlar K, Stretz E, Vollrath R, Przybilla B, Flaig M. Predictors of clinical effectiveness of Hymenoptera venom immunotherapy. Clin Exp Allergy 2014; 44:736-46. [DOI: 10.1111/cea.12275] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/07/2013] [Accepted: 12/17/2013] [Indexed: 12/21/2022]
Affiliation(s)
- F. Ruëff
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | - B. Vos
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
- Department of Allergology; University of Groningen; University Medical Center Groningen; RB Groningen the Netherlands
- GRIAC research institute; University of Groningen; University Medical Center Groningen; AV Groningen the Netherlands
| | - J. Oude Elberink
- Department of Allergology; University of Groningen; University Medical Center Groningen; RB Groningen the Netherlands
- GRIAC research institute; University of Groningen; University Medical Center Groningen; AV Groningen the Netherlands
| | - A. Bender
- Statistical Consulting Unit; Department of Statistics; Ludwig-Maximilian University; Munich Germany
| | - R. Chatelain
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
- Fakultät für Gesundheit der Universität Witten/Herdecke; Witten Germany
| | - S. Dugas-Breit
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | - H.-P. Horny
- Department of Pathology; Ludwig-Maximilian University; Munich Germany
| | - H. Küchenhoff
- Statistical Consulting Unit; Department of Statistics; Ludwig-Maximilian University; Munich Germany
| | - A. Linhardt
- Department of Psychiatry and Psychotherapy; Ludwig-Maximilian University; Munich Germany
| | - S. Mastnik
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | - K. Sotlar
- Department of Pathology; Ludwig-Maximilian University; Munich Germany
| | - E. Stretz
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | - R. Vollrath
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | - B. Przybilla
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
| | - M. Flaig
- Department of Dermatology and Allergology; Ludwig-Maximilian University; Munich Germany
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Xie C, Xu S, Ding F, Xie M, Lv J, Yao J, Pan D, Sun Q, Liu C, Chen T, Li S, Wang W. Clinical features of severe wasp sting patients with dominantly toxic reaction: analysis of 1091 cases. PLoS One 2013; 8:e83164. [PMID: 24391743 PMCID: PMC3877022 DOI: 10.1371/journal.pone.0083164] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 10/30/2013] [Indexed: 11/23/2022] Open
Abstract
Background Massive wasp stings have been greatly underestimated and have not been systematically studied. The aim of this study was to identify the clinical features and treatment strategies of severe wasp stings. Methods and Findings A multicenter retrospective study was undertaken in 35 hospitals and medical centers including 12 tertiary care hospitals and 23 secondary care hospitals in the Hubei Province, China. The detailed clinical data of 1091 hospitalized wasp sting patients were investigated. Over three-fourths (76.9%) of the cases had 10 or more stings and the in-hospital mortality of patients was 5.1%. Forty-eight patients died of organ injury following toxic reactions to the stings, whereas six died from anaphylactic shock. The in-hospital mortality in patients with >10 stings was higher than that of ≤10 stings (5.2% vs. 1.0%, p = 0.02). Acute kidney injury (AKI) was seen in 21.0% patients and most patients required blood purification therapy. Rhabdomyolysis was seen in 24.1% patients, hemolysis in 19.2% patients, liver injury in 30.1% patients, and coagulopathy in 22.5% patients. Regression analysis revealed that high creatinine level, shock, oliguria, and anemia were risk factors for death. Blood purification therapy was beneficial for patients with ≥20 stings and delayed hospital admission of patients (≥4 hours after sting). Conclusions In China, most patients with multiple wasp stings presented with toxic reactions and multiple organ dysfunction caused by the venom rather than an anaphylactic reaction. AKI is the prominent clinical manifestation of wasp stings with toxic reaction. High creatinine levels, shock, oliguria, and anemia were risk factors for death.
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Affiliation(s)
- Cuihong Xie
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shabei Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fengfei Ding
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Minjie Xie
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiagao Lv
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihua Yao
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dengji Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qian Sun
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chenchen Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tie Chen
- Division of Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Shusheng Li
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail: (SL); (WW)
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- * E-mail: (SL); (WW)
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Kumar V, Nada R, Kumar S, Ramachandran R, Rathi M, Kohli HS, Sakhuja V, Jha V. Acute kidney injury due to acute cortical necrosis following a single wasp sting. Ren Fail 2012; 35:170-2. [PMID: 23173621 DOI: 10.3109/0886022x.2012.741467] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Acute kidney injury (AKI) can develop after multiple wasp or bee stings. The etiology is the acute tubular necrosis secondary to shock, pigment toxicity, interstitial nephritis, or direct nephrotoxicity of venom. We report a 40-year-old female who presented with oliguric AKI after a single wasp sting on her hand. Her history, examination, and investigations did not support any of the established causes of AKI in such settings. She did not improve with supportive management and dialysis, and kidney biopsy showed acute cortical necrosis (ACN). This is the first report of ACN after a single wasp sting.
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Affiliation(s)
- Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Evaluation of a Novel Rapid Test System for the Detection of Specific IgE to Hymenoptera Venoms. J Allergy (Cairo) 2012; 2012:862023. [PMID: 22500188 PMCID: PMC3303699 DOI: 10.1155/2012/862023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 11/25/2011] [Accepted: 11/26/2011] [Indexed: 12/02/2022] Open
Abstract
Background. The Allergy Lateral Flow Assay (ALFA) is a novel rapid assay for the detection of sIgE to allergens. The objective of this study is the evaluation of ALFA for the detection of sIgE to bee venom (BV) and wasp venom (WV) in insect venom allergic patients. Methods. Specific IgE to BV and WV was analyzed by ALFA, ALLERG-O-LIQ, and ImmunoCAP in 80 insect venom allergic patients and 60 control sera. Sensitivity and specificity of ALFA and correlation of ALFA and ImmunoCAP results were calculated. Results. The sensitivity/specificity of ALFA to the diagnosis was 100%/83% for BV and 82%/97% for WV. For insect venom allergic patients, the Spearman correlation coefficient for ALFA versus ImmunoCAP was 0.79 for BV and 0.80 for WV. However, significant differences in the negative control groups were observed. Conclusion. ALFA represents a simple, robust, and reliable tool for the rapid detection of sIgE to insect venoms.
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Current world literature. Curr Opin Allergy Clin Immunol 2011; 11:497-502. [PMID: 21878753 DOI: 10.1097/aci.0b013e32834bbdcd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Current world literature. Curr Opin Allergy Clin Immunol 2011; 11:150-6. [PMID: 21368622 DOI: 10.1097/aci.0b013e3283457ab0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Viswanathan S, Prabhu C, Arulneyam J, Remalayam B, Adil M. Yellow jacket envenomation-related acute renal failure. Clin Kidney J 2011; 4:167-9. [PMID: 25984147 PMCID: PMC4421610 DOI: 10.1093/ndtplus/sfr020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 02/09/2011] [Indexed: 11/16/2022] Open
Abstract
We report a 58-year-old man with multiple yellow jacket stings who developed urticaria, renal failure, quadriparesis, rhabdomyolysis in succession. Investigations revealed renal and hepatic dysfunction, proteinuria, demyelinating polyradiculoneuropathy, acute tubular necrosis and glomerulonephritis. He improved with methylprednisolone, antihypertensives and two sessions of haemodialysis.
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Affiliation(s)
- Stalin Viswanathan
- Department of Internal Medicine, Pondicherry Institute of Medical Sciences, Kalapet, Pondicherry, South India
| | - Chaitanya Prabhu
- Department of Nephrology, Pondicherry Institute of Medical Sciences, Kalapet, Pondicherry, South India
| | - Jayanthi Arulneyam
- Department of Neurology, Pondicherry Institute of Medical Sciences, Kalapet, Pondicherry
| | - Bhavith Remalayam
- Department of Internal Medicine, Pondicherry Institute of Medical Sciences, Kalapet, Pondicherry, South India
| | - Mohammed Adil
- Department of Internal Medicine, Pondicherry Institute of Medical Sciences, Kalapet, Pondicherry, South India
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