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Rodríguez-Vázquez V, López-Freire S, Méndez-Brea P, González-Fernández MT, Hernández-Pérez C, Vidal C. [Basophil activation test to follow-up of patients treated with hymenoptera venom immunotherapy: a review of current evidence]. REVISTA ALERGIA MÉXICO 2023; 69:125-137. [PMID: 36869012 DOI: 10.29262/ram.v69i3.1135] [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: 06/13/2022] [Accepted: 10/22/2022] [Indexed: 02/05/2023] Open
Abstract
Hymenoptera venom immunotherapy (HVI) is a long-term effective treatment to avoid new systemic reactions in patients with Hymenoptera allergy. The sting challenge test is considered the gold standard to confirm the tolerance. However, the use of this technique is not generalized in clinical practice, being the basophil activation test (BAT), which functionally explores allergen response, an alternative that does not entail any of the provocation risks associated with the sting challenge test. This study reviews the publications that used the BAT to follow up and evaluate the success of the HVI. Studies assessing the changes between a baseline BAT before the start and BATs performed between the starting and maintenance phases of the HVI were selected. Ten articles were found, comprising information from 167 patients, of which 29% used the sting challenge test. The studies concluded the importance of evaluating the responses with submaximal allergen concentrations, which reflect basophil sensitivity, to monitor the HVI using the BAT. It was also observed that changes in the maximum response (reactivity) could not reflect the clinical status of tolerance, particularly in the initial phases of HVI.
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Affiliation(s)
- Virginia Rodríguez-Vázquez
- Servicio de Alergología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España.
| | - Sara López-Freire
- Servicio de Alergología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | - Paula Méndez-Brea
- Servicio de Alergología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | | | | | - Carmen Vidal
- Servicio de Alergología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España.,Facultad de Medicina, Universidad de Santiago de Compostela, España
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Long-term impact of hymenoptera venom immunotherapy on clinical course, immune parameters, and psychosocial aspects. Allergol Select 2021; 5:57-66. [PMID: 33521509 PMCID: PMC7841418 DOI: 10.5414/alx02175e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/30/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Venom immunotherapy (VIT) is highly efficient in subjects suffering from IgE-mediated allergy to hymenoptera venom (HV), and VIT results in substantial improvement of quality of life (QoL). However, VIT-induced tolerance may be lost over time after cessation of treatment, putting patients at risk of re-sting anaphylaxis. MATERIALS AND METHODS To study the effect of VIT on maintenance of HV tolerance we evaluated the natural history of 54 patients who were treated with VIT up to 29 years ago, with a special focus on re-stings and their subsequent course. Furthermore, we analyzed HV-specific IgE, IgG, and IgG4 antibody titers. Finally, we assessed the long-term impact of VIT on various psychosocial aspects like dealing with hymenoptera exposures, daily life activities, self-assurance, and personal environment. RESULTS 29 (53.7%) subjects experienced at least one re-sting after stopping VIT, with 23 (79%) showing no systemic reaction (SR). Eleven of these (37.9%) took emergency drugs as a safety measurement. Six individuals (21%) showed loss of tolerance experiencing an anaphylactic reaction. No difference in HV-specific IgE, IgG4, or IgG antibody concentrations was noticed among the different patients. Subjects who tolerated a re-sting without applying emergency drugs felt least affected in their social-behavioral leisure activities when hymenoptera were around or by anxiety for new stings. CONCLUSION VIT leads to long-term tolerance in the majority of HV-allergic patients, however, ~ 1/5 may lose protection over time, arguing for continued follow-up on VIT-treated subjects and keeping them equipped with an emergency kit. Notably, VIT also results in a lasting, strong impact on self-assurance and sense of well-being in individuals who tolerated a re-sting without employing emergency drugs, which emphasizes the need to use them only in case of systemic symptoms after stopping successful VIT.
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Expression of eosinophils, RANTES and IL-25 in the first phase of Hymenoptera venom immunotherapy. Postepy Dermatol Alergol 2019; 37:590-596. [PMID: 32994784 PMCID: PMC7507153 DOI: 10.5114/ada.2019.83655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/24/2019] [Indexed: 01/08/2023] Open
Abstract
Introduction Venom immunotherapy (VIT) can protect against severe anaphylactic reactions (SR) in 80–100% of subjects allergic to Hymenoptera venom. The mechanisms of induction of immunological tolerance produced by VIT are still little known. It has been shown that VIT modulates Treg activity, Th2 or Th1 cells or both, increases production of IL-10, decreases secretion of IL-13, and causes an IgG4/IgE ratio shift. Aim To investigate the blood eosinophil count, CCL5/RANTES and IL-17E/IL-25 concentrations before and after the initial phases of the rush protocol of VIT. Material and methods Forty individuals (14 males, 26 females) of mean age 41.03 ±12.43 years were included in the study. The peripheral eosinophils and the concentration of serum interleukin IL-17E/IL-25 and RANTES were determined before and after the initial phase of VIT. Results Paired sample t-test revealed that all patients after VIT had significantly higher eosinophil levels compared to the baseline (mean: 0.42 vs. 0.64, p < 0.05). Moreover, in subjects treated with bee venom, RANTES levels proved to rise significantly (51 × 103 vs. 62 × 103, p < 0.05) while IL-17E/IL-25 dropped with near-marginal significance (916 vs. 650, p = 0.069). Conclusions Our immunological study on the early phase of venom immunotherapy suggested that eosinophils, cytokines such as CCL5/RANTES and IL-17E/IL-25 contribute to the immunological response.
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Albanesi M, Nico A, Sinisi A, Giliberti L, Rossi MP, Rossini M, Kourtis G, Rucco AS, Loconte F, Muolo L, Zurlo M, Di Bona D, Caiaffa MF, Macchia L. A 13-year real-life study on efficacy, safety and biological effects of Vespula venom immunotherapy. Clin Mol Allergy 2018; 16:2. [PMID: 29375272 PMCID: PMC5774115 DOI: 10.1186/s12948-017-0079-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background Hymenoptera venom immunotherapy (VIT) is a clinically effective treatment. However, little is known about its long-term clinical efficacy and biological effects. Several mechanisms have been proposed to account for VIT efficacy, including reduction of specific IgE and induction of allergen-specific IgG4, but the overall picture remains elusive. We investigated Vespula VIT clinical efficacy up to 8 years after discontinuation and the kinetics of Vespula-specific IgE and IgG4. Out of 686 consecutive patients we retrospectively selected and analysed a series of 23 patients with Vespula allergy that underwent a 5-year IT course, followed by a prolonged follow-up. Methods Clinical efficacy of VIT was assessed as number and severity of reactions to Vespula re-stinging events. The presence of Vespula-specific IgE and IgG4 was also monitored over time. Results During the VIT treatment, patients were protected, reporting no reactions or mild reactions in occasion of re-stinging events. This protection was entirely maintained during the follow-up, up to 8 years. Skin reactivity (reflecting mast cell-bound Vespula-specific IgE) and circulating Vespula-specific IgE levels declined substantially during VIT. Notably, this reduction was maintained over time during the follow-up. Moreover, all the patients were analysed for IgG4. A robust induction of Vespula-specific IgG4 was observed during the VIT course, with a substantial decline during the follow-up. Conclusions We conclude that Vespula VIT is a clinically effective treatment, which induces long-term protection after discontinuation. The reduction of specific IgE, assessed by skin tests and RAST, closely matches the VIT- induced protection, while the IgG4 induction seems not to be associated with VIT clinical efficacy in the long term. Electronic supplementary material The online version of this article (10.1186/s12948-017-0079-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marcello Albanesi
- 1School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari-Aldo Moro, Piazza Giulio Cesare 13, Policlinico, 70124 Bari, Italy
| | - Andrea Nico
- 1School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari-Aldo Moro, Piazza Giulio Cesare 13, Policlinico, 70124 Bari, Italy
| | - Alessandro Sinisi
- 1School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari-Aldo Moro, Piazza Giulio Cesare 13, Policlinico, 70124 Bari, Italy
| | - Lucia Giliberti
- 1School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari-Aldo Moro, Piazza Giulio Cesare 13, Policlinico, 70124 Bari, Italy
| | - Maria Pia Rossi
- 1School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari-Aldo Moro, Piazza Giulio Cesare 13, Policlinico, 70124 Bari, Italy
| | - Margherita Rossini
- Unit of Clinical Pathology, Policlinico di Bari, Piazza Giulio Cesare 13, Policlinico, 70124 Bari, Italy
| | - Georgios Kourtis
- 1School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari-Aldo Moro, Piazza Giulio Cesare 13, Policlinico, 70124 Bari, Italy
| | - Anna Simona Rucco
- 1School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari-Aldo Moro, Piazza Giulio Cesare 13, Policlinico, 70124 Bari, Italy
| | - Filomena Loconte
- 1School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari-Aldo Moro, Piazza Giulio Cesare 13, Policlinico, 70124 Bari, Italy
| | - Loredana Muolo
- 1School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari-Aldo Moro, Piazza Giulio Cesare 13, Policlinico, 70124 Bari, Italy
| | - Marco Zurlo
- 1School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari-Aldo Moro, Piazza Giulio Cesare 13, Policlinico, 70124 Bari, Italy
| | - Danilo Di Bona
- 1School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari-Aldo Moro, Piazza Giulio Cesare 13, Policlinico, 70124 Bari, Italy
| | - Maria Filomena Caiaffa
- 3School and Chair of Allergology and Clinical Immunology, Department of Medical and Surgical Sciences, University of Foggia, Via Luigi Pinto 1, 70100 Foggia, Italy
| | - Luigi Macchia
- 1School and Chair of Allergology and Clinical Immunology, Department of Emergency and Organ Transplantation, University of Bari-Aldo Moro, Piazza Giulio Cesare 13, Policlinico, 70124 Bari, Italy
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