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Bilò MB, Golden DBK, Braschi MC, Martini M. Should Patients With a Large Local Reaction be Offered Venom Immunotherapy? A Pro-Con Debate. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00685-8. [PMID: 38972507 DOI: 10.1016/j.jaip.2024.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/09/2024]
Abstract
Insect stings can cause large local reactions (LLRs) that are IgE-mediated and associated with considerable morbidity. A risk for systemic reactions including anaphylaxis to subsequent stings has been reported and is often noted by patients and health care providers. Guidelines do not recommend venom immunotherapy (VIT) for LLRs based on the relatively low risk of anaphylaxis, but this is debated in this review. On the pro side: the risk of anaphylaxis may be higher than reported in the limited literature, especially in patients who had only 1 LLR; new species with more potent stings are spreading into new areas; the quality of life can be markedly impaired by LLRs; and VIT is generally safe and highly effective. On the con side: LLRs are benign, stings occur infrequently, VIT has significant cost, systemic reactions occur more often to VIT than to stings in patients with LLRs, and Food and Drug Administration approval and published guidelines do not recommend VIT for LLRs. In practice, shared decision-making is appropriate to incorporate knowledge of the natural history and known high-risk factors in the context of the patient's personal values and preferences.
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Affiliation(s)
- M Beatrice Bilò
- Allergy Unit, Department of Internal Medicine, University Hospital AOU delle Marche, Ancona, Italy; Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - David B K Golden
- Division of Allergy-Clinical Immunology, Johns Hopkins School of Medicine, Baltimore, Md.
| | - M Chiara Braschi
- Allergy Unit, Department of Internal Medicine, University Hospital AOU delle Marche, Ancona, Italy
| | - Matteo Martini
- Allergy Unit, Department of Internal Medicine, University Hospital AOU delle Marche, Ancona, Italy; Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
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Buyuktiryaki B, Hela F, Ozturk AB, Dursun AB, Donmez H, Gelincik A, Yegit OO, Yavuz ST, Sahiner UM, Albayrak O, Damadoglu E, Erdogan T, Firtina S, Taylan D, Soyer O, Karakaya G, Kalyoncu AF, Sekerel B, Sackesen C. Clinical features, severity, and immunological changes during venom immunotherapy in children and adults. Allergy Asthma Proc 2024; 45:276-283. [PMID: 38982596 DOI: 10.2500/aap.2024.45.240017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Background: Hymenoptera venom allergy (HVA) is among the most common causes of severe allergic reactions worldwide. Objective: To investigate clinical features and factors that affect the severity of HVA and to determine the alterations in immunologic biomarkers after venom immunotherapy (VIT). Methods: Seventy-six adults and 36 children were prospectively investigated. We analyzed specific immunoglobulin E (sIgE) and sIgG4 levels of venom extracts and components (rApi m1, rApi m10, rVes v1, rVes v5, rPol d5) before and after the first year of VIT. Results: Although cardiovascular symptoms were more common in adults (p < 0.001), the skin was the most affected organ in children (p = 0.009). Serum basal tryptase (sBT) levels were higher in the adults than the children (p < 0.001). The absence of urticaria (odds ratio [OR] 4.208 [95% confidence interval {CI}, 1.395-12.688]; p = 0.011) and sBT ≥ 5.2 ng/mL (OR 11.941 [95% CI, 5.220-39.733]; p < 0.001) were found as the risk factors for grade IV reactions. During VIT, changes in sIgE levels were variable. In the Apis VIT group, we observed remarkable increases in sIgG4 levels in Apis extract and rApi m1 but not in Api m10. Vespula extract, rVes v1, and rVes v5 sIgG4 levels were significantly increased in Vespula VIT group, we also detected significant increases in the Polistes extract and rPol d5 sIgG4 levels, which were not observed in the Apis VIT group. In the patients who received both Apis and Vespula VIT, increases in sIgG4 levels were observed for both venoms. Conclusion: Adults and children can have different clinical patterns. After 1 year, VIT induced a strong IgG4 response. Although Apis immunotherapy (IT) induced Apis sIgG4, excluding Api m10, Vespula IT induced both Vespula and Polistes sIgG4.
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Affiliation(s)
- Betul Buyuktiryaki
- From the Division of Pediatric Allergy, School of Medicine, Department of Pediatrics, Koc University, Istanbul, Turkey
| | - Francesko Hela
- Research Center for Translational Medicine, Graduate School of Health Sciences, Koc University, Istanbul, Turkey
| | - Ayse Bilge Ozturk
- Division of Allergy and Immunology, Department of Pulmonary Medicine, School of Medicine, Medeniyet University, Istanbul, Turkey
| | - Adile Berna Dursun
- Division of Allergy, and Immunology, Department of Internal Medicine, School of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Halil Donmez
- Division of Allergy, and Immunology, Department of Internal Medicine, School of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Asli Gelincik
- Division of Immunology and Allergy Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Osman Ozan Yegit
- Division of Immunology and Allergy Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Suleyman Tolga Yavuz
- Department of Pediatric Allergy, Children's Hospital, University of Bonn, Bonn, Germany
| | - Umit Murat Sahiner
- Division of Allergy, Department of Pediatrics, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Ozgur Albayrak
- Flow Cytometry Core Facility, Research Center for Translational Medicine, Istanbul, Turkey
| | - Ebru Damadoglu
- Division of Allergy and Immunology, Department of Pulmonary Medicine, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Tuba Erdogan
- Division of Immunology and Allergy, Department of Internal Medicine, School of Medicine, Baskent University, Ankara, Turkey, and
| | - Sinem Firtina
- Clinical Laboratory, American Hospital, Istanbul, Turkey
| | - Dilber Taylan
- Clinical Laboratory, American Hospital, Istanbul, Turkey
| | - Ozge Soyer
- Division of Allergy, Department of Pediatrics, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Gul Karakaya
- Division of Allergy and Immunology, Department of Pulmonary Medicine, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- Division of Allergy and Immunology, Department of Pulmonary Medicine, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Bulent Sekerel
- Division of Allergy, Department of Pediatrics, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Cansin Sackesen
- From the Division of Pediatric Allergy, School of Medicine, Department of Pediatrics, Koc University, Istanbul, Turkey
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Treudler R. Emerging and Novel Elicitors of Anaphylaxis: Collegium Internationale Allergologicum Update 2024. Int Arch Allergy Immunol 2024; 185:794-802. [PMID: 38527454 DOI: 10.1159/000537958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/19/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Anaphylaxis represents the most severe end of the spectrum of allergic reactions. Frequent elicitors of anaphylaxis are insects, foods, and drugs. This paper summarizes recent development with regard to emerging and novel elicitors of anaphylaxis. SUMMARY Food allergens on the rise include pulses (like pea, chickpea), seeds (hemp, chia), nuts (cashew), pseudograins (buckwheat, quinoa), fruits, and microalgae. Novel foods are foods that were not consumed to any significant extent in the European Union before May 1997, which includes four edible insects (mealworm, migratory locust, house cricket, and buffalo worm). Recent investigations have pointed out the risk of anaphylaxis associated with the consumption of yellow mealworm for people allergic to shellfish and house dust mites. In Europe, fire ants (mostly Solenopsis invicta) and Vespa velutina nigrithorax represent invasive species, which account for increasing numbers of anaphylactic reactions. Also, several new drugs, especially biologicals, have been associated with anaphylaxis. KEY MESSAGES Elicitors of anaphylaxis are changing as a result of (i) increase in demand for plant-based food, (ii) introduction of novel foods, (iii) spreading of allergens by climate changes and globalization, or (iv) due to exposure to newly developed drugs.
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Affiliation(s)
- Regina Treudler
- Charité - Universitätsmedizin Berlin, Institute of Allergology IFA, Berlin, Germany
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López-Freire S, Armisén M, Cruz MJ, Vidal C. Evaluation of the Cytokine Response Induced by Specific Allergen Immunotherapy in Patients with Vespa velutina Anaphylaxis. Int Arch Allergy Immunol 2024; 185:456-459. [PMID: 38412847 DOI: 10.1159/000536488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Changes in the cytokine profile from type 2 to type 1 together with the induction of regulatory cells are expected during hymenoptera venom immunotherapy (VIT). The present study was aimed to investigate the changes in type 1, type 2, and regulatory cytokines induced by a Vespula spp. VIT in patients with anaphylaxis to Vespa velutina. METHODS Twenty consecutive patients with anaphylaxis due to Vespa velutina were treated with Vespula spp. VIT. Serum cytokines (IL-4, IL-5, IL-10, IL-13, and IFN-ɣ) were measured at baseline, 6, and 12 months after starting VIT. RESULTS A significant increase in serum IFN-y was detected after 6 and 12 months of VIT. An increase in serum IL-10 and a decrease in IL-5 were observed after 12 months. IL-4 was undetectable all along the study, and an unexpected increase of IL-13 was present at 12 months of treatment. CONCLUSION Vespula spp. VIT seems to be able to induce a shift to type 1 cytokine production measured through IFN-y levels and IL-10 production after, at least, 6 and 12 months of VIT, respectively.
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Affiliation(s)
- Sara López-Freire
- Allergy Department, Complejo Hospitalario Universitario de Santiago, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Margarita Armisén
- Allergy Department, Complejo Hospitalario Universitario de Santiago, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Carmen Vidal
- Allergy Department, Complejo Hospitalario Universitario de Santiago, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
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Ruëff F. [Insect venom allergies-What will change in times of global change?]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:126-133. [PMID: 38214725 DOI: 10.1007/s00105-023-05277-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND In Germany, honeybees (Apis mellifera) and various Vespula species (wasps) are primarily relevant for hypersensitivity reactions to stings. Hornets (Vespa crabro), bumblebees, paper wasps (Polistes) and yellowjackets (Dolichovespula) less frequently cause sting reactions. OBJECTIVE What effects do intensive agricultural utilization and climate change have on the living conditions and occurrence of Hymenoptera and what consequences do they have for the diagnostics and treatment of hypersensitivity reactions to Hymenoptera stings. MATERIAL AND METHODS A literature search was carried out. RESULTS Honeybees and wild bees are endangered due to introduced diseases, invasive species and pesticides. The aim of widespread beekeeping activity is to protect honeybees, which is why no reduction in stings is to be expected despite increased bee mortality. In Germany, there is evidence of the spread of thermophilic Polistes species (paper wasps) from south to north and the immigration of Vespa velutina nigrithorax (Asian hornet). It is unlikely that these species will lead to a significant increase in sting reactions. Nests of the red fire ant (Solenopsis invicta), which was originally common in South America, were first detected in Sicily in 2022. Red fire ants are aggressive insects with a high potential for adverse sting reactions. CONCLUSION Invasive insects must be considered as a trigger in the anamnesis and diagnostics. Diagnostics are only available for the detection of Polistes sensitization. Therapeutic allergens can be obtained from other European countries for venom immunotherapy of a Polistes allergy. Due to cross-reactivity, diagnostic and therapeutic allergens from Vespula spp. are used for the diagnosis and treatment of suspected allergies to the Asian hornet.
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Affiliation(s)
- Franziska Ruëff
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, Frauenlobstr. 9-11, 80337, München, Deutschland.
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Cichocka-Jarosz E, Brzyski P, Jedynak-Wąsowicz U, Mól N, Klasa B, Mazurek-Durlak Z, Lis G, Nowak-Węgrzyn A. Skin prick tests are not useful for the qualification for venom immunotherapy in children. World Allergy Organ J 2023; 16:100775. [PMID: 37351272 PMCID: PMC10282561 DOI: 10.1016/j.waojou.2023.100775] [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: 10/12/2022] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 06/24/2023] Open
Abstract
Background The basis for qualification for venom immunotherapy (VIT) is the fulfilment of both the clinical and immunological criteria. Diagnostic tests that confirm the immunological criterion of an IgE-mediated sensitization include skin prick tests (SPT), intradermal tests (IDT), and serum specific IgE (sIgE) for the culprit venom. Objective This study aimed to assess the usefulness of SPT as the immunological marker in the diagnosis of insect venom sensitization in children with history of systemic reaction (SR) to insect sting evaluated by means of I-IV-grades Mueller's scale. There are no such studies in children. Methods This cross-sectional study sample consisted of 416 children aged 3-18 years (mean age 10.6 ± 3.8), 76% males, all with the history of a systemic reaction (SR) after a Hymenoptera sting (48% of grade III/IV according to Mueller scale), diagnosed between 1999 and 2019 in the tertiary referral centre. The standard diagnostic tests were used. Specificity, sensitivity, and positive and negative predictive values were computed to assess the diagnostic properties of the clinical tests to distinguish between mild and severe SR. To assess the relative value of an individual test in predicting the qualification to VIT we incorporated the Shapley value (SV). Results Positive SPT results were found in up to no more than 3% of children; among them less than 1% had only positive SPT and were negative for sIgE and IDT. Approximately 85% of the children had detectable venom sIgE, followed by positive IDT (75%). Almost 70% of children had positive both sIgE and IDT results. In children with grade III/IV reaction, about 80% of children had positive results of both of these tests. sIgE and IDT had sensitivity >0.80, whereas SPT had high specificity (>0.97) in differentiating between mild and severe SR. Relative value of diagnostic tests in predicting qualification to VIT varied between venoms. Bee venom IDT had higher SV (0.052) than sIgE (0.041). In contrast, wasp venom sIgE had higher SV (0.075) than IDT (0.035). Conclusion SPTs are not an useful immunological marker of venom sensitization in children, and eliminating SPT does not result in a loss of diagnostic accuracy. Limiting diagnostics to venom sIgE and IDT would shorten the procedure and reduce costs. Future studies are needed to determine if venom sIgE as the first line diagnostic test, with IDT added only if the venom sIgE is undetectable, is an optimal diagnostic process.
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Affiliation(s)
- Ewa Cichocka-Jarosz
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | | | - Urszula Jedynak-Wąsowicz
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | - Nina Mól
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | - Barbara Klasa
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | - Zofia Mazurek-Durlak
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | - Grzegorz Lis
- Department of Paediatrics, Jagiellonian University Medical College, 265 Wielicka St, 30-663 Krakow, Poland
| | - Anna Nowak-Węgrzyn
- Department of Pediatrics at NYU Grossman School of Medicine, New York, USA
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Alonso-Sampedro M, Feás X, Bravo SB, Chantada-Vázquez MP, Vidal C. Proteomics of Vespa velutina nigrithorax Venom Sac Queens and Workers: A Quantitative SWATH-MS Analysis. Toxins (Basel) 2023; 15:toxins15040266. [PMID: 37104204 PMCID: PMC10144020 DOI: 10.3390/toxins15040266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/20/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
Health risks caused by stings from Vespa velutina nigrithorax (VV), also known as the yellow-legged Asian hornet, have become a public concern, but little is known about its venom composition. This study presents the proteome profile of the VV’s venom sac (VS) based on Sequential Window Acquisition of all Theoretical Mass Spectra (SWATH-MS). The study also performed proteomic quantitative analysis and examined the biological pathways and molecular functions of the proteins in the VS of VV gynes (i.e., future queens [SQ]) and workers [SW]. The total protein content per VS was significantly higher in the SW than in the SQ (274 ± 54 µg/sac vs. 175 ± 22 µg/sac; p = 0.02). We quantified a total of 228 proteins in the VS, belonging to 7 different classes: Insecta (n = 191); Amphibia and Reptilia (n = 20); Bacilli, γ-Proteobacteria and Pisoniviricetes (n = 12); and Arachnida (n = 5). Among the 228 identified proteins, 66 showed significant differential expression between SQ and SW. The potential allergens hyaluronidase A, venom antigen 5 and phospholipase A1 were significantly downregulated in the SQ venom.
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Affiliation(s)
- Manuela Alonso-Sampedro
- Fundación Instituto de Investigación Sanitaria de Santiago de Compostela (FIDIS), Hospital Clínico, 15706 Santiago de Compostela, Spain
- Research Methods Group (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS-ISCIII/RD21/0016/0022), University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Xesús Feás
- Fundación Instituto de Investigación Sanitaria de Santiago de Compostela (FIDIS), Hospital Clínico, 15706 Santiago de Compostela, Spain
- Universitat Carlemany, Av. Verge de Canòlich, 47 AD600 Sant Julià de Lòria, Andorra
- Academy of Veterinary Sciences of Galicia, 15707 Santiago de Compostela, Spain
| | - Susana Belén Bravo
- Fundación Instituto de Investigación Sanitaria de Santiago de Compostela (FIDIS), Hospital Clínico, 15706 Santiago de Compostela, Spain
- Proteomic Unit, Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - María Pilar Chantada-Vázquez
- Fundación Instituto de Investigación Sanitaria de Santiago de Compostela (FIDIS), Hospital Clínico, 15706 Santiago de Compostela, Spain
- Proteomic Unit, Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
| | - Carmen Vidal
- Fundación Instituto de Investigación Sanitaria de Santiago de Compostela (FIDIS), Hospital Clínico, 15706 Santiago de Compostela, Spain
- Research Methods Group (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS-ISCIII/RD21/0016/0022), University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Allergy Department, University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, Faculty of Medicine, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
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8
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Miranda J, Mesquita AM, Plácido J, Coimbra A. Vespa velutina nigrithorax venom allergy - Real life clinical practice. Ann Allergy Asthma Immunol 2022; 129:524-525. [PMID: 35914661 DOI: 10.1016/j.anai.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/07/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Joana Miranda
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João E.P.E, Porto, Portugal.
| | - Ana M Mesquita
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João E.P.E, Porto, Portugal.
| | - José Plácido
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João E.P.E, Porto, Portugal.
| | - Alice Coimbra
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João E.P.E, Porto, Portugal.
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Pretre G, Asturias JA, Lizaso MT, Tabar AI. Dipeptidyl peptidase IV of the Vespa velutina nigrithorax venom is recognized as a relevant allergen. Ann Allergy Asthma Immunol 2022; 129:101-105. [PMID: 35247597 DOI: 10.1016/j.anai.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/08/2022] [Accepted: 02/15/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vespa velutina nigrithorax (VVN), commonly known as "the Asian yellow-legged wasp," has been one of the most significant invasive species in western Europe since 2010. Currently, VVN has become the most prevalent cause of Hymenoptera anaphylaxis in north and northwestern Spain. For this reason, it is crucial to diagnose anaphylaxis cases in the acute moment for carrying out the best available treatment as soon as possible. OBJECTIVE To achieve a complete understanding of the venom allergen composition that will help to develop efficient diagnostics and immunotherapy treatments based on this venom. METHODS In this work, autochthonous VVN venom was obtained and characterized by SDS-PAGE, isoelectric focusing, followed by a mass spectrometry analysis. In addition, the allergenic sensitization profile of patients diagnosed with allergy to VVN in the Allergology Service of Navarra University Hospital between the years 2017-2020 was studied by immunoblotting and specific IgE (ImmunoCAP). RESULTS Two new allergens (dipeptidyl peptidase IV and serin protease) were identified in the autochthonous VVN venom, and their identity was confirmed by LC-MS analysis. The study by ImmunoCAP using sera from 12 patients who suffered a systemic reaction after a VVN sting revealed group 5 and group 1 as predominant allergens (92% and 34%, respectively). Furthermore, the immunoblotting assay showed a recognition of the dipeptidyl peptidase IV (50%) by the sera of these patients. CONCLUSION A serin protease and the dipeptidyl peptidase IV are components of the VVN venom, and this last one is an allergen recognized in the studied population.
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Affiliation(s)
- Gabriela Pretre
- R&D Department, ROXALL Medicina España S.A., Zamudio, Spain.
| | | | | | - Ana Isabel Tabar
- Servicio de Alergología. Hospital Universitario de Navarra, Pamplona, Spain
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10
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Ruiz-Leon B, Serrano P, Vidal C, Moreno-Aguilar C. Management of Double Sensitization to Vespids in Europe. Toxins (Basel) 2022; 14:toxins14020126. [PMID: 35202153 PMCID: PMC8880449 DOI: 10.3390/toxins14020126] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 12/10/2022] Open
Abstract
Wasp allergy with a diagnostic profile of double sensitizations to vespid venom is a frequent clinical problem in areas where different genera of wasps are present. Identification of the insect responsible for serious reactions poses a diagnostic challenge as the only effective treatment to date is immunotherapy based on the specific venom. In southern Europe, the double sensitization to Vespula and Polistes venoms is highly frequent. It has been shown that the major allergenic proteins (Phospholipase A1 and Antigen 5) share sequences across the different genera and species, which would be the cause of cross-reactivity. Additionally, the minor allergens (Dipeptidyl-peptidases, Vitellogenins) have been found to share partial sequence identity. Furthermore, venom contains other homologous proteins whose allergenic nature still remains to be clarified. The traditional diagnostic tools available are insufficient to discriminate between allergy to Vespula and Polistes in a high number of cases. IgE inhibition is the technique that best identifies the cross-reactivity. When a double sensitization has indeed been shown to exist or great uncertainty surrounds the primary sensitization, therapy with two venoms is advisable to guarantee the safety of the patient. In this case, a strategy involving alternate administration that combines effectiveness with efficiency is possible.
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Affiliation(s)
- Berta Ruiz-Leon
- Allergy Section of University Hospital Reina Sofia-IMIBIC, ARADyAL Network, National Institute of Health Carlos III, 14005 Cordoba, Spain; (B.R.-L.); (C.M.-A.)
| | - Pilar Serrano
- Allergy Section of University Hospital Reina Sofia-IMIBIC, ARADyAL Network, National Institute of Health Carlos III, 14005 Cordoba, Spain; (B.R.-L.); (C.M.-A.)
- Correspondence:
| | - Carmen Vidal
- Allergy Department of Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| | - Carmen Moreno-Aguilar
- Allergy Section of University Hospital Reina Sofia-IMIBIC, ARADyAL Network, National Institute of Health Carlos III, 14005 Cordoba, Spain; (B.R.-L.); (C.M.-A.)
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11
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Vidal C. The Asian wasp Vespa velutina nigrithorax: Entomological and allergological characteristics. Clin Exp Allergy 2021; 52:489-498. [PMID: 34822191 DOI: 10.1111/cea.14063] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/31/2021] [Accepted: 11/22/2021] [Indexed: 12/12/2022]
Abstract
The yellow-legged or Asian wasp (Vespa velutina nigrithorax) has spread rapidly across Europe since its first introduction in France, in 2004. Originally from South-East Asia, it is considered an invasive species outside its native region. Apart from the ecological and economic implications of its presence, it may cause health problems to humans due to the toxic and allergenic components of its venom. Vespa velutina nigrithorax has become the most prevalent cause of anaphylaxis due to Hymenoptera venom in some regions of Spain. Although sIgE against both antigen 5 (Vesp v 5) and A1-phospholipase (Vesp v 1) has been detected in these patients, only Vesp v 5 may be considered a dominant allergen. Interestingly, Vesp v 1 appears to be a glycosylated allergen different from A1-phospholipases from other species. Inhibition studies suggest that Vespula spp venom could behave as primary sensitizer. Besides, changes in sIgE and sIgG4 during Vespula venom immunotherapy in patients with anaphylaxis due to V. velutina support the use of Vespula venom extracts to treat these patients. The purpose of this review is to explore the biological behaviour of V. velutina and to summarize the current knowledge of the allergic reactions provoked by this wasp.
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Affiliation(s)
- Carmen Vidal
- Allergy Department, Complejo Hospitalario Universitario de Santiago, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
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