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Stratopoulos E, Leonardou A, Pitsios C. Hymenoptera Venom Immunotherapy Meets Factitious Disorder. Cureus 2024; 16:e55769. [PMID: 38586777 PMCID: PMC10998981 DOI: 10.7759/cureus.55769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Factitious disorder on self is a psychiatric disorder in which individuals fabricate or induce signs or symptoms of a disease. Factitious anaphylaxis, with symptoms suggestive of a life-threatening allergic reaction, is extremely rare. Several cases of factitious disorder reactions during allergen immunotherapy for airborne allergens have been reported. We report the case of a young female patient who presented factitious anaphylaxis during venom immunotherapy to vespid venom extract. Symptoms of stridor, dyspnea, coughing and loss of consciousness were observed during the built-up phase of venom immunotherapy, mimicking allergic reactions to the venom extracts. Diagnosis of factitious disorder prompted the discontinuation of venom immunotherapy.
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Affiliation(s)
| | - Angeliki Leonardou
- Psychiatry, Women's Mental Health Clinic, National and Kapodistrian University of Athens, Athens, GRC
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Cardoso Lopes J, Botelho Alves P, Pires Pereira H, Cunha F, Farinha I, Maresch A, Cunha R, Loureiro G, Todo-Bom A, Tavares B. Molecular profiling in bee venom allergy: clinical and therapeutic characterization in a Portuguese cohort. Eur Ann Allergy Clin Immunol 2024. [PMID: 38376470 DOI: 10.23822/eurannaci.1764-1489.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Summary Background. Bee venom allergy (BVA) can trigger local and systemic allergic reactions, including anaphylaxis. Recently, the molecular sensitization profile has gained importance in the reaction's stratification and venom immunotherapy (VIT). Methods. Retrospective analysis of patients with hypersensitivity to BVA, confirmed by specific sIgE to Apis mellifera ≥0.35 kU/L and/or positive skin tests to bee venom commercial extract, evaluated in specialized consultation. Demographic, clinical, and laboratory data (including molecular Api m 1, 4, and 10) were analyzed, looking for risk factors associated with the severity of the index reaction and reactions during VIT. Results. 93 patients were included (55.9% male; median age of 46 years), 57.3% with atopic comorbidities, and 23.4% with cardiovascular comorbidities. The median specific IgE to Apis mellifera was 6.7 kU/L (IQR 1.0-20.3) kU/L. Regarding the molecular profile, the median IgE to Api m 1 was 0.5 kU/L (57.5% positive out of all measurements); Api m 4 - 0.01 kU/L (11.9% positive), and Api m 10 - 0.3 kU/L (50.0% positive). No patient was monosensitized to Api m 4. The median age of the most severe sting reaction was 36 (IQR 26-48) years, with a median severity (Müeller scale) of 3 (IQR 2-3). Forty-seven patients (50.5%) underwent VIT, with 35.6% of reactions recorded. Allergic reactions during VIT were recorded in 35.6% of cases. The severity of the index reaction correlated positively with older ages (p=0.040; r=0.249), in contrast to monosensitization to Api m 1, which was an independent predictor of milder reactions (p=0.015). Sensitization to Api m 10 was associated with a higher likelihood of reactions during VIT (p=0.038) but potentially less systemic reactions at re-stings (p=0.097). Conclusions. Molecular sensitization profile appears to be relevant not only to the severity of index reactions but also during VIT. Studies of a large cohort of patients with molecular profiles are essential to validate these results and improve the clinical and therapeutic approach to BVA.
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Affiliation(s)
- J Cardoso Lopes
- Department of Allergy and Clinical Immunology, Coimbra Hospital and University Center, Coimbra, Portugal
| | - P Botelho Alves
- Department of Allergy and Clinical Immunology, Coimbra Hospital and University Center, Coimbra, Portugal
| | - H Pires Pereira
- Department of Allergy and Clinical Immunology, Coimbra Hospital and University Center, Coimbra, Portugal
| | - F Cunha
- Department of Allergy and Clinical Immunology, Coimbra Hospital and University Center, Coimbra, Portugal
| | - I Farinha
- Department of Allergy and Clinical Immunology, Coimbra Hospital and University Center, Coimbra, Portugal
| | - A Maresch
- Department of Clinical Pathology, Coimbra Hospital and University Center, Coimbra, Portugal
| | - R Cunha
- Department of Clinical Pathology, Coimbra Hospital and University Center, Coimbra, Portugal
| | - G Loureiro
- Department of Allergy and Clinical Immunology, Coimbra Hospital and University Center, Coimbra, Portugal
| | - A Todo-Bom
- Department of Allergy and Clinical Immunology, Coimbra Hospital and University Center, Coimbra, Portugal
- Coimbra Clinical Academic Center, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - B Tavares
- Department of Allergy and Clinical Immunology, Coimbra Hospital and University Center, Coimbra, Portugal
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Rijavec M, Inkret J, Bidovec-Stojković U, Carli T, Frelih N, Kukec A, Korošec P, Košnik M. Fatal Hymenoptera Venom-Triggered Anaphylaxis in Patients with Unrecognized Clonal Mast Cell Disorder-Is Mastocytosis to Blame? Int J Mol Sci 2023; 24:16368. [PMID: 38003556 PMCID: PMC10671356 DOI: 10.3390/ijms242216368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Hymenoptera venom-triggered anaphylaxis (HVA) affects up to 8.9% of the general population and is the most frequent cause of anaphylaxis in adults, accounting for approximately 20% of all fatal anaphylaxis cases. Quite often, a fatal reaction is a victim's first manifestation of HVA. Mastocytosis represents one of the most important risk factors for severe HVA. We analyzed patients with documented fatal HVA for the presence of underlying clonal mast cell disorder (cMCD). Here, we report three cases of fatal HVA, with undiagnosed underlying cMCD identified by the presence of the peripheral blood and/or bone marrow KIT p.D816V missense variant postmortem. In the first case, anaphylaxis was the initial episode and was fatal. In the other two cases, both patients were treated with specific venom immunotherapy (VIT), nevertheless, one died of HVA after VIT discontinuation, and the other during VIT; both patients had cardiovascular comorbidities and were taking beta-blockers and/or ACE inhibitors. Our results point to the importance of screening all high-risk individuals for underlying cMCD using highly sensitive molecular methods for peripheral blood KIT p.D816V variant detection, including severe HVA and possibly beekeepers, for proper management and the need for lifelong VIT to prevent unnecessary deaths. Patients at the highest risk of fatal HVA, with concomitant cardiovascular and cMCD comorbidities, might not be protected from field stings even during regular VIT. Therefore, two adrenaline autoinjectors and lifelong VIT, and possibly cotreatment with omalizumab, should be considered for high-risk patients to prevent fatal HVA episodes.
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Affiliation(s)
- Matija Rijavec
- University Clinic of Respiratory and Allergic Diseases Golnik, 4204 Golnik, Slovenia; (U.B.-S.)
- Biotechnical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Jezerka Inkret
- Institute of Forensic Medicine, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Urška Bidovec-Stojković
- University Clinic of Respiratory and Allergic Diseases Golnik, 4204 Golnik, Slovenia; (U.B.-S.)
| | - Tanja Carli
- National Institute of Public Health, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Nina Frelih
- University Clinic of Respiratory and Allergic Diseases Golnik, 4204 Golnik, Slovenia; (U.B.-S.)
| | - Andreja Kukec
- National Institute of Public Health, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Peter Korošec
- University Clinic of Respiratory and Allergic Diseases Golnik, 4204 Golnik, Slovenia; (U.B.-S.)
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Mitja Košnik
- University Clinic of Respiratory and Allergic Diseases Golnik, 4204 Golnik, Slovenia; (U.B.-S.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Ruëff F, Bauer A, Becker S, Brehler R, Brockow K, Chaker AM, Darsow U, Fischer J, Fuchs T, Gerstlauer M, Gernert S, Hamelmann E, Hötzenecker W, Klimek L, Lange L, Merk H, Mülleneisen NK, Neustädter I, Pfützner W, Sieber W, Sitter H, Skudlik C, Treudler R, Wedi B, Wöhrl S, Worm M, Jakob T. Diagnosis and treatment of Hymenoptera venom allergy: S2k Guideline of the German Society of Allergology and Clinical Immunology (DGAKI) in collaboration with the Arbeitsgemeinschaft für Berufs- und Umweltdermatologie e.V. (ABD), the Medical Association of German Allergologists (AeDA), the German Society of Dermatology (DDG), the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNOKC), the German Society of Pediatrics and Adolescent Medicine (DGKJ), the Society for Pediatric Allergy and Environmental Medicine (GPA), German Respiratory Society (DGP), and the Austrian Society for Allergy and Immunology (ÖGAI). Allergol Select 2023; 7:154-190. [PMID: 37854067 PMCID: PMC10580978 DOI: 10.5414/alx02430e] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 10/20/2023] Open
Abstract
Hymenoptera venom (HV) is injected into the skin during a sting by Hymenoptera such as bees or wasps. Some components of HV are potential allergens and can cause large local and/or systemic allergic reactions (SAR) in sensitized individuals. During their lifetime, ~ 3% of the general population will develop SAR following a Hymenoptera sting. This guideline presents the diagnostic and therapeutic approach to SAR following Hymenoptera stings. Symptomatic therapy is usually required after a severe local reaction, but specific diagnosis or allergen immunotherapy (AIT) with HV (VIT) is not necessary. When taking a patient's medical history after SAR, clinicians should discuss possible risk factors for more frequent stings and more severe anaphylactic reactions. The most important risk factors for more severe SAR are mast cell disease and, especially in children, uncontrolled asthma. Therefore, if the SAR extends beyond the skin (according to the Ring and Messmer classification: grade > I), the baseline serum tryptase concentration shall be measured and the skin shall be examined for possible mastocytosis. The medical history should also include questions specific to asthma symptoms. To demonstrate sensitization to HV, allergists shall determine concentrations of specific IgE antibodies (sIgE) to bee and/or vespid venoms, their constituents and other venoms as appropriate. If the results are negative less than 2 weeks after the sting, the tests shall be repeated (at least 4 - 6 weeks after the sting). If only sIgE to the total venom extracts have been determined, if there is double sensitization, or if the results are implausible, allergists shall determine sIgE to the different venom components. Skin testing may be omitted if in-vitro methods have provided a definitive diagnosis. If neither laboratory diagnosis nor skin testing has led to conclusive results, additional cellular testing can be performed. Therapy for HV allergy includes prophylaxis of reexposure, patient self treatment measures (including use of rescue medication) in the event of re-stings, and VIT. Following a grade I SAR and in the absence of other risk factors for repeated sting exposure or more severe anaphylaxis, it is not necessary to prescribe an adrenaline auto-injector (AAI) or to administer VIT. Under certain conditions, VIT can be administered even in the presence of previous grade I anaphylaxis, e.g., if there are additional risk factors or if quality of life would be reduced without VIT. Physicians should be aware of the contraindications to VIT, although they can be overridden in justified individual cases after weighing benefits and risks. The use of β-blockers and ACE inhibitors is not a contraindication to VIT. Patients should be informed about possible interactions. For VIT, the venom extract shall be used that, according to the patient's history and the results of the allergy diagnostics, was the trigger of the disease. If, in the case of double sensitization and an unclear history regarding the trigger, it is not possible to determine the culprit venom even with additional diagnostic procedures, VIT shall be performed with both venom extracts. The standard maintenance dose of VIT is 100 µg HV. In adult patients with bee venom allergy and an increased risk of sting exposure or particularly severe anaphylaxis, a maintenance dose of 200 µg can be considered from the start of VIT. Administration of a non-sedating H1-blocking antihistamine can be considered to reduce side effects. The maintenance dose should be given at 4-weekly intervals during the first year and, following the manufacturer's instructions, every 5 - 6 weeks from the second year, depending on the preparation used; if a depot preparation is used, the interval can be extended to 8 weeks from the third year onwards. If significant recurrent systemic reactions occur during VIT, clinicians shall identify and as possible eliminate co-factors that promote these reactions. If this is not possible or if there are no such co-factors, if prophylactic administration of an H1-blocking antihistamine is not effective, and if a higher dose of VIT has not led to tolerability of VIT, physicians should should consider additional treatment with an anti IgE antibody such as omalizumab as off lable use. For practical reasons, only a small number of patients are able to undergo sting challenge tests to check the success of the therapy, which requires in-hospital monitoring and emergency standby. To perform such a provocation test, patients must have tolerated VIT at the planned maintenance dose. In the event of treatment failure while on treatment with an ACE inhibitor, physicians should consider discontinuing the ACE inhibitor. In the absence of tolerance induction, physicians shall increase the maintenance dose (200 µg to a maximum of 400 µg in adults, maximum of 200 µg HV in children). If increasing the maintenance dose does not provide adequate protection and there are risk factors for a severe anaphylactic reaction, physicians should consider a co-medication based on an anti-IgE antibody (omalizumab; off-label use) during the insect flight season. In patients without specific risk factors, VIT can be discontinued after 3 - 5 years if maintenance therapy has been tolerated without recurrent anaphylactic events. Prolonged or permanent VIT can be considered in patients with mastocytosis, a history of cardiovascular or respiratory arrest due to Hymenoptera sting (severity grade IV), or other specific constellations associated with an increased individual risk of recurrent and/or severe SAR (e.g., hereditary α-tryptasemia). In cases of strongly increased, unavoidable insect exposure, adults may receive VIT until the end of intense contact. The prescription of an AAI can be omitted in patients with a history of SAR grade I and II when the maintenance dose of VIT has been reached and tolerated, provided that there are no additional risk factors. The same holds true once the VIT has been terminated after the regular treatment period. Patients with a history of SAR grade ≥ III reaction, or grade II reaction combined with additional factors that increase the risk of non response or repeated severe sting reactions, should carry an emergency kit, including an AAI, during VIT and after regular termination of the VIT.
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Affiliation(s)
- Franziska Ruëff
- Department of Dermatology and Allergy, LMU University Hospital, Munich
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden
| | - Sven Becker
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Tuebingen, Tübingen
| | - Randolf Brehler
- Department of Dermatology, Münster University Hospital, Münster
| | - Knut Brockow
- Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University of Munich, Munich
| | - Adam M. Chaker
- Department of Otorhinolaryngology Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich
| | - Ulf Darsow
- Department of Dermatology and Allergology Biederstein, Faculty of Medicine, Technical University of Munich, Munich
| | - Jörg Fischer
- University Hospital for Dermatology and Allergology, Clinic Oldenburg, Oldenburg
| | - Thomas Fuchs
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen
| | - Michael Gerstlauer
- Clinic for Children and Adolescents, University Hospital Augsburg, Augsburg
| | | | - Eckard Hamelmann
- Children’s Center Bethel, University Hospital OWL, Bielefeld University, Bielefeld, Germany
| | - Wolfram Hötzenecker
- Department of Dermatology, Kepler University Hospital, Medical Faculty of University Linz, Linz, Austria
| | | | - Lars Lange
- Pediatric Clinic, Marienhospital Bonn, GFO Kliniken, Bonn
| | - Hans Merk
- Department of Dermatology and Allergology, University Hospital of RWTH Aachen University, Aachen
| | | | | | - Wolfgang Pfützner
- Department of Dermatology and Allergology, University Hospital Marburg, Philipps-Universität Marburg, Marburg
| | | | - Helmut Sitter
- Institute for Theoretical Surgery, Philipps-University Marburg, Marburg
| | - Christoph Skudlik
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrueck, Osnabrueck, and BG Clinic Hamburg, Hamburg
| | | | - Bettina Wedi
- Comprehensive Allergy, Department of Dermatology and Allergy, Hannover Medical School, Hanover, Germany
| | - Stefan Wöhrl
- Floridsdorf Allergy Center (FAZ), Vienna, Austria
| | - Margitta Worm
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, and
| | - Thilo Jakob
- Department of Dermatology and Allergology, University Hospital Giessen, Justus Liebig University Gießen, Gießen, Germany
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Rostaher A, Fischer NM, Vigani A, Steblaj B, Martini F, Brem S, Favrot C, Kosnik M. Hymenoptera Venom Immunotherapy in Dogs: Safety and Clinical Efficacy. Animals (Basel) 2023; 13:3002. [PMID: 37835609 PMCID: PMC10571593 DOI: 10.3390/ani13193002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
Hymenoptera allergens are the main triggers for anaphylaxis in susceptible dogs and humans. Hymenoptera venom specific immunotherapy (VIT), the only disease-modifying treatment, has the potential to prevent future life-threatening reactions in human patients. Prospective clinical data on VIT efficacy in dogs are currently lacking. Therefore, the aim of this study was to show that VIT is not only safe but also efficacious in preventing anaphylaxis in dogs allergic to Hymenoptera. This uncontrolled prospective clinical trial included 10 client-owned dogs with a history of anaphylaxis following repeated Hymenoptera stings. The sensitization to bee and wasp allergens was demonstrated by intradermal testing (IDT) and allergen-specific IgE serology. For VIT induction (induction phase), dogs received a shortened rush immunotherapy protocol with aqueous allergens, which was then followed by monthly injections of 100 µg of alum-precipitated allergen (maintenance phase). VIT efficacy was determined by observing patients' clinical reactions to re-stings. No systemic adverse events were seen during the induction and maintenance phases. From the seven re-stung dogs, only one developed a mild angioedema at the site of the sting; the remaining dogs were asymptomatic. These results show that VIT represents a safe and effective treatment option for Hymenoptera-allergic dogs.
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Affiliation(s)
- Ana Rostaher
- Dermatology Unit, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (N.M.F.); (F.M.); (S.B.); (C.F.)
| | - Nina Maria Fischer
- Dermatology Unit, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (N.M.F.); (F.M.); (S.B.); (C.F.)
| | - Alessio Vigani
- Division of Small Animal Emergency and Critical Care, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland;
| | - Barbara Steblaj
- Section of Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland;
| | - Franco Martini
- Dermatology Unit, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (N.M.F.); (F.M.); (S.B.); (C.F.)
| | - Salina Brem
- Dermatology Unit, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (N.M.F.); (F.M.); (S.B.); (C.F.)
| | - Claude Favrot
- Dermatology Unit, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland; (N.M.F.); (F.M.); (S.B.); (C.F.)
| | - Mitja Kosnik
- Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, 4204 Golnik, Slovenia;
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Saretta F, Giovannini M, Pessina B, Barni S, Liccioli G, Sarti L, Tomei L, Fazi C, Pegoraro F, Valleriani C, Ricci S, Azzari C, Novembre E, Mori F. Venom immunotherapy protocols in the pediatric population: how to choose? Front Pediatr 2023; 11:1192081. [PMID: 37744438 PMCID: PMC10512975 DOI: 10.3389/fped.2023.1192081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/05/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Mattia Giovannini
- Department of Health Sciences, University of Florence, Florence, Italy
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Benedetta Pessina
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Simona Barni
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Giulia Liccioli
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Lucrezia Sarti
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Leonardo Tomei
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Camilla Fazi
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Silvia Ricci
- Department of Health Sciences, University of Florence, Florence, Italy
- Immunology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Chiara Azzari
- Department of Health Sciences, University of Florence, Florence, Italy
- Immunology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Elio Novembre
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
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Wanandy T, Le TTA, Lau WY, Wiese MD, Heddle RJ, Brown SGA. The development of Jack Jumper ant venom immunotherapy: our 25 years' experience. Intern Med J 2023; 53:1716-1721. [PMID: 37743244 DOI: 10.1111/imj.16217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/29/2023] [Indexed: 09/26/2023]
Abstract
Jack Jumper ant venom allergy is a uniquely Australian medical issue. The stinging ant is a leading cause of insect venom allergy in south-eastern Australia. An effective venom immunotherapy-based treatment was successfully developed by the Tasmanian Jack Jumper Allergy Research group. This paper provides a synopsis of our 25 years' research journey in developing this evidence-based treatment modality.
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Affiliation(s)
- Troy Wanandy
- Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program, Royal Hobart Hospital, Hobart, Tasmania, Australia
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Thanh-Thao A Le
- Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Wun Y Lau
- Department of Clinical Immunology and Allergy, Incorporating the Jack Jumper Allergy Program, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Michael D Wiese
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Robert J Heddle
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Simon G A Brown
- Division of Emergency Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia
- Aeromedical and Medical Retrieval Division, Ambulance Tasmania, Hobart, Tasmania, Australia
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Grosch J, Lesur A, Kler S, Bernardin F, Dittmar G, Francescato E, Hewings SJ, Jakwerth CA, Zissler UM, Heath MD, Ollert M, Kramer MF, Hilger C, Bilò MB, Schmidt-Weber CB, Blank S. Allergen Content of Therapeutic Preparations for Allergen-Specific Immunotherapy of European Paper Wasp Venom Allergy. Toxins (Basel) 2022; 14:284. [PMID: 35448893 DOI: 10.3390/toxins14040284] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 11/26/2022] Open
Abstract
Allergy to Polistes dominula (European paper wasp) venom is of particular relevance in Southern Europe, potentially becoming a threat in other regions in the near future, and can be effectively cured by venom immunotherapy (VIT). As allergen content in extracts may vary and have an impact on diagnostic and therapeutic approaches, the aim was to compare five therapeutic preparations for VIT of P. dominula venom allergy available in Spain. Products from five different suppliers were analyzed by SDS-PAGE and LC-MS/MS and compared with a reference venom sample. Three products with P. dominula venom and one product with a venom mixture of American Polistes species showed a comparable band pattern in SDS-PAGE as the reference sample and the bands of the major allergens phospholipase A1 and antigen 5 were assignable. The other product, which consists of a mixture of American Polistes species, exhibited the typical band pattern in one, but not in another sample from a second batch. All annotated P. dominula allergens were detected at comparable levels in LC-MS/MS analysis of products containing P. dominula venom. Due to a lack of genomic information on the American Polistes species, the remaining products were not analyzed by this method. The major Polistes allergens were present in comparable amounts in the majority, but not in all investigated samples of venom preparations for VIT of P. dominula venom allergy.
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Rosiek-Biegus M, Pawłowicz R, Kopeć A, Kosińska M, Wrześniak M, Nittner-Marszalska M. Component-Resolved Evaluation of the Risk and Success of Immunotherapy in Bee Venom Allergic Patients. J Clin Med 2022; 11. [PMID: 35330002 DOI: 10.3390/jcm11061677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/21/2022] [Accepted: 03/15/2022] [Indexed: 12/04/2022] Open
Abstract
Venom immunotherapy (VIT) is the only efficient therapy for the Hymenoptera insect venom allergy. Immunotherapy with bee venom is encumbered with a higher risk of systemic side effects and/or therapeutic failures. The objective of the study was to assess if specific profiles of molecular IgE (Immunoglobulin E) responses are associated with an increased risk of systemic side effects and/or the treatment’s inefficacy. The study group numbered 64 bee venom allergic patients (BVA) who received venom immunotherapy modo ultra-rush (VIT-UR), (f/m: 32/32, mean age 43.4 ± 17.2). In total, 54.84% of them manifested allergic reactions of grades I-III (acc. to Mueller’s scale), while 48.66% manifested reactions of grade IV. In all the patients, IgE against bee venom extract, rApi m 1 and tryptase (sBT) were assessed. In 46 patients, assessments of IgE against rApi m 2, 3, 5, 10 were also performed. BVA patients manifesting cardiovascular symptoms (SYS IV0) showed higher levels of both sIgE-rApi m 5 (p = 0.03) and tryptase (p = 0.07) than patients with SYS I−III. Systemic adverse events during VIT with bee venom were more frequent in the induction phase than in the maintenance phase: 15.22% vs. 8.7%. In BVA patients who experienced systemic adverse events during VIT, higher concentrations of sIgE-rApi m 5 (p < 0.05), rApi m 1 (p = 0.009), and sBT (p = 0.019) were demonstrated. We conclude that higher levels of sIgE against rApi m 1, rApi m 5, and tryptase many constitute a potential marker of the severity of allergic reactions and therapeutic complications that can occur during VIT with bee venom.
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Pitsios C, Petalas K, Dimitriou A, Parperis K, Gerasimidou K, Chliva C. Workup and Clinical Assessment for Allergen Immunotherapy Candidates. Cells 2022; 11:cells11040653. [PMID: 35203303 PMCID: PMC8870157 DOI: 10.3390/cells11040653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 02/06/2023] Open
Abstract
Allergen Immunotherapy (AIT) is a well-established, efficient, and safe way to treat respiratory and insect-venom allergies. After determining the diagnosis of the clinically relevant culprit allergen, AIT can be prescribed. However, not all patients are eligible for AIT, since some diseases/conditions represent contraindications to AIT use, as described in several guidelines. Allergists are often preoccupied on whether an extensive workup should be ordered in apparently healthy AIT candidates in order to detect contra-indicated diseases and conditions. These preoccupations often arise from clinical, ethical and legal issues. The aim of this article is to suggest an approach to the workup and assessment of the presence of any underlying diseases/conditions in patients with no case history before the start of AIT. Notably, there is a lack of published studies on the appropriate evaluation of AIT candidates, with no globally accepted guidelines. It appears that Allergists are mostly deciding based on their AIT training, as well as their clinical experience. Guidance is based mainly on experts’ opinions; the suggested preliminary workup can be divided into mandatory and optional testing. The evaluation for possible underlying neoplastic, autoimmune, and cardiovascular diseases, primary and acquired immunodeficiencies and pregnancy, might be helpful but only in subjects for whom the history and clinical examination raise suspicion of these conditions. A workup without any reasonable correlation with potential contraindications is useless. In conclusion, the evaluation of each individual candidate for possible medical conditions should be determined on a case-by-case basis.
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Affiliation(s)
| | - Konstantinos Petalas
- Department of Allergy and Clinical Immunology, 251 General Airforce Hospital, 155 61 Athens, Greece;
| | | | | | - Kyriaki Gerasimidou
- Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - Caterina Chliva
- Allergy Unit, 2nd Department of Dermatology and Venereology, “Attikon” General University Hospital, 124 61 Haidari, Greece;
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12
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Nittner-Marszalska M, Guranski K, Bladowska J, Kopeć A, Ejma M. Ischemic stroke as a rare complication of wasp venom allergy: two clinical scenarios. Cent Eur J Immunol 2022; 47:288-91. [PMID: 36817263 DOI: 10.5114/ceji.2022.119153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/29/2022] [Indexed: 11/17/2022] Open
Abstract
Neurological complications after a single Hymenoptera insect sting are very rare. The authors of this paper describe two instances of cerebral ischemic stroke that occurred immediately after a wasp sting. Two distinct pathomechanisms involved in the cases are put forward. When diagnosing such cases, it is vital to rule out the possibility of an immunoglobulin E (IgE)-dependent reaction of hypersensitivity. However, if sIgE antibodies against wasp venom extract and/or its allergenic components are detected, after hospitalization the patient should be qualified for venom immunotherapy, which is the only efficient method of protection from severe allergic reactions caused by an insect sting. Although the incidence of ischemic stroke in patients stung by insects is very low, it is important to be aware of this complication. This will allow rapid implementation of appropriate diagnostics and treatment. The optimal stroke treatment (thrombolysis or mechanical thrombectomy) in these rare cases has not yet been established.
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13
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Castagnoli R, Giovannini M, Mori F, Barni S, Pecoraro L, Arasi S, Saretta F, Mastrorilli C, Liotti L, Caminiti L, Sturm GJ, Marseglia GL, Novembre E. Unusual Reactions to Hymenoptera Stings: Current Knowledge and Unmet Needs in the Pediatric Population. Front Med (Lausanne) 2021; 8:717290. [PMID: 34901051 PMCID: PMC8661053 DOI: 10.3389/fmed.2021.717290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
Hymenoptera stings are generally well-tolerated and usually cause limited local reactions, characterized by self-resolving erythema and edema associated with pain. However, Hymenoptera stings can induce immediate and delayed hypersensitivity reactions. In addition to these manifestations, unusual reactions to Hymenoptera stings have been reported. The latter are defined as unusual because of their atypical characteristics. They may differ from classical hypersensitivity reactions due to the stings' particular localization and the unusual involvement of one or more specific organs. Although unusual reactions to Hymenoptera stings are infrequent, it is essential for clinicians to know the possible related clinical manifestations. Here, we review the available literature and propose a diagnostic and management algorithm. At present, there are no defined guidelines for most of the unusual reactions to Hymenoptera stings, which should be managed in a tailored way according to the specifical clinical manifestations presented by the patients. Further studies are needed to better define these conditions and the underlying pathogenetic mechanisms to improve the diagnostic and therapeutic approach.
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Affiliation(s)
- Riccardo Castagnoli
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Luca Pecoraro
- Department of Medicine, University of Verona, Policlinico GB Rossi, Verona, Italy.,Pediatric Unit, ASST Mantua, Mantua, Italy
| | - Stefania Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Carla Mastrorilli
- Pediatric Unit and Emergency, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, Bari, Italy
| | - Lucia Liotti
- Department of Pediatrics, Salesi Children's Hospital, AOU Ospedali Riuniti Ancona, Ancona, Italy
| | - Lucia Caminiti
- Department of Human Pathology in Adult and Development Age "Gaetano Barresi," Allergy Unit, Department of Pediatrics, AOU Policlinico Gaetano Martino, Messina, Italy
| | - Gunter Johannes Sturm
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria.,Allergy Outpatient Clinic Reumannplatz, Vienna, Austria
| | - Gian Luigi Marseglia
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Elio Novembre
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Sturm GJ, Herzog SA, Aberer W, Alfaya Arias T, Antolín‐Amérigo D, Bonadonna P, Boni E, Bożek A, Chełmińska M, Ernst B, Frelih N, Gawlik R, Gelincik A, Hawranek T, Hoetzenecker W, Jiménez Blanco A, Kita K, Kendirlinan R, Košnik M, Laipold K, Lang R, Marchi F, Mauro M, Nittner‐Marszalska M, Poziomkowska‐Gęsicka I, Pravettoni V, Preziosi D, Quercia O, Reider N, Rosiek‐Biegus M, Ruiz‐Leon B, Schrautzer C, Serrano P, Sin A, Sin BA, Stoevesandt J, Trautmann A, Vachová M, Arzt‐Gradwohl L. β-blockers and ACE inhibitors are not a risk factor for severe systemic sting reactions and adverse events during venom immunotherapy. Allergy 2021; 76:2166-2176. [PMID: 33605465 PMCID: PMC8359427 DOI: 10.1111/all.14785] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/06/2021] [Accepted: 01/20/2021] [Indexed: 11/28/2022]
Abstract
Background There is controversy whether taking β‐blockers or ACE inhibitors (ACEI) is a risk factor for more severe systemic insect sting reactions (SSR) and whether it increases the number or severity of adverse events (AE) during venom immunotherapy (VIT). Methods In this open, prospective, observational, multicenter trial, we recruited patients with a history of a SSR and indication for VIT. The primary objective of this study was to evaluate whether patients taking β‐blockers or ACEI show more systemic AE during VIT compared to patients without such treatment. Results In total, 1,425 patients were enrolled and VIT was performed in 1,342 patients. Of all patients included, 388 (27.2%) took antihypertensive (AHT) drugs (10.4% took β‐blockers, 11.9% ACEI, 5.0% β‐blockers and ACEI). Only 5.6% of patients under AHT treatment experienced systemic AE during VIT as compared with 7.4% of patients without these drugs (OR: 0.74, 95% CI: 0.43–1.22, p = 0.25). The severity of the initial sting reaction was not affected by the intake of β‐blockers or ACEI (OR: 1.14, 95% CI: 0.89–1.46, p = 0.29). In total, 210 (17.7%) patients were re‐stung during VIT and 191 (91.0%) tolerated the sting without systemic symptoms. Of the 19 patients with VIT treatment failure, 4 took β‐blockers, none an ACEI. Conclusions This trial provides robust evidence that taking β‐blockers or ACEI does neither increase the frequency of systemic AE during VIT nor aggravate SSR. Moreover, results suggest that these drugs do not impair effectiveness of VIT. (Funded by Medical University of Graz, Austria; Clinicaltrials.gov number, NCT04269629).
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Affiliation(s)
- Gunter Johannes Sturm
- Department of Dermatology and Venereology Medical University of Graz Graz Austria
- Allergy Outpatient Clinic Reumannplatz Vienna Austria
| | - Sereina Annik Herzog
- Center for Health Economics Research and Modelling Infectious Diseases (CHERMID) Vaccine & Infectious Disease Institute (VAXINFECTIO) University of Antwerp Antwerp Belgium
- Institute for Medical Informatics, Statistics, and Documentation Medical University of Graz Graz Austria
| | - Werner Aberer
- Department of Dermatology and Venereology Medical University of Graz Graz Austria
| | - Teresa Alfaya Arias
- Allergy UnitHospital General Universitario de Ciudad Real & Hospital Universitario Fundación Alcorcón Madrid Spain
| | - Darío Antolín‐Amérigo
- Servicio de Enfermedades del Sistema Inmune‐Alergia Hospital Universitario Príncipe de Asturias Departamento de Medicina y EspecialidadesMédicas Universidad de Alcalá Madrid Spain
- Servicio de Alergia Hospital Universitario Ramón y Cajal (IRYCIS Madrid Spain
| | | | - Elisa Boni
- Laboratorio Unico Metropolitano Maggiore Hospital Bologna Italy
| | - Andrzej Bożek
- Clinical Department of Internal Diseases, Dermatology, and Allergology Medical University of Silesia Zabrze Poland
| | - Marta Chełmińska
- Allergology Department Medical University of Gdańsk Gdańsk Poland
| | - Barbara Ernst
- Department of Dermatology General Hospital Ordensklinikum Linz GmbH Elisabethinen Linz Austria
| | - Nina Frelih
- University Clinic of Respiratory and Allergic Diseases Golnik Slovenia
| | - Radoslaw Gawlik
- Department of Internal Medicine, Allergy, and Clinical Immunology Silesian University of Medicine Katowice Poland
| | - Asli Gelincik
- Department of Internal Medicine Division of Immunology and Allergic Diseases Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Thomas Hawranek
- Department of Dermatology and Allergology Paracelsus Medical University Salzburg Salzburg Austria
| | - Wolfram Hoetzenecker
- Department of Dermatology Kepler University Hospital and Medical FacultyJohannes Kepler University Linz Austria
| | - Aránzazu Jiménez Blanco
- Allergy Unit Hospital Central de la Cruz Roja Faculty of Medicine Alfonso X El Sabio UniversityARADyAL Madrid Spain
| | - Karolina Kita
- Allergology Department Medical University of Gdańsk Gdańsk Poland
| | - Reşat Kendirlinan
- Department of Pulmonary Diseases Division of Immunology and Allergy Faculty of Medicine Ankara University Ankara Turkey
| | - Mitja Košnik
- University Clinic of Respiratory and Allergic Diseases, Golnik and Medical Faculty Ljubljana Ljubljana Slovenia
| | - Karin Laipold
- Department of Dermatology and Venereology Medical University of Graz Graz Austria
| | - Roland Lang
- Department of Dermatology and Allergology Paracelsus Medical University Salzburg Salzburg Austria
| | - Francesco Marchi
- SD Allergologia ClinicaAzienda Ospedaliero‐Universitaria Pisana Pisa Italy
| | | | - Marita Nittner‐Marszalska
- Department of Internal Diseases, Pulmonology and Allergology Medical University of Wroclaw Wroclaw Poland
| | | | - Valerio Pravettoni
- UOC General Medicine Immunology and Allergology IRCCS Foundation CaGranda Ospedale Maggiore Policlinico Milan Italy
| | | | - Oliviero Quercia
- High Specialization Unit of Allergology Hospital of Faenza AUSL (Local Health Unit) of Romagna Romagna Italy
| | - Norbert Reider
- Department of Dermatology, Venereology, and Allergology Medical University of Innsbruck Innsbruck Austria
| | - Marta Rosiek‐Biegus
- Department of Internal Diseases, Pulmonology and Allergology Medical University of Wroclaw Wroclaw Poland
| | - Berta Ruiz‐Leon
- Maimonides Biomedical Research Institute of Cordoba (IMIBICAvenida Menéndez Pidal S/N Córdoba Spain
- Unidad de GestiónClínica de Inmunoalergia & ARADyAL Research Network Reina Sofía University Hospital Córdoba Spain
| | - Christoph Schrautzer
- Department of Dermatology and Venereology Medical University of Graz Graz Austria
| | - Pilar Serrano
- Maimonides Biomedical Research Institute of Cordoba (IMIBICAvenida Menéndez Pidal S/N Córdoba Spain
- Unidad de GestiónClínica de Inmunoalergia & ARADyAL Research Network Reina Sofía University Hospital Córdoba Spain
| | - Aytül Sin
- Department of Internal Medicine Division of Allergy and Immunology Medical Faculty Ege University Izmir Turkey
| | - Betül Ayşe Sin
- Department of Pulmonary Diseases Division of Immunology and Allergy Faculty of Medicine Ankara University Ankara Turkey
| | - Johanna Stoevesandt
- Department of Dermatology and Allergy University Hospital Würzburg Würzburg Germany
| | - Axel Trautmann
- Department of Dermatology and Allergy University Hospital Würzburg Würzburg Germany
| | - Martina Vachová
- Department of Immunology and Allergology Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic
| | - Lisa Arzt‐Gradwohl
- Department of Dermatology and Venereology Medical University of Graz Graz Austria
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Dubini M, Pravettoni V, Rivolta F, Segatto G, Asero R, Montano N. Remission of a case of multiple Hymenoptera stings-associated chronic urticaria during venom immunotherapy. Clin Case Rep 2021; 9:e04188. [PMID: 34026184 PMCID: PMC8133085 DOI: 10.1002/ccr3.4188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/23/2021] [Accepted: 04/04/2021] [Indexed: 12/04/2022] Open
Abstract
Hymenoptera stings mostly cause acute urticaria but we describe a case of CU after wasp stings which remitted during venom immunotherapy. IgE-mechanisms have not been fully clarified in CU, except for isolated circumstances. In our case immunotherapy has played a positive role reducing immune cells reactivity and improving urticaria symptoms.
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Affiliation(s)
- Marco Dubini
- Allergy and Clinical Immunology ResidencyUniversity of MilanMilanItaly
| | - Valerio Pravettoni
- General Medicine, Immunology and Allergology UnitIRCCS Foundation Ca' GrandaOspedale Maggiore PoliclinicoMilanItaly
| | - Federica Rivolta
- General Medicine, Immunology and Allergology UnitIRCCS Foundation Ca' GrandaOspedale Maggiore PoliclinicoMilanItaly
| | - Giulia Segatto
- Allergy and Clinical Immunology ResidencyUniversity of MilanMilanItaly
| | | | - Nicola Montano
- General Medicine, Immunology and Allergology UnitIRCCS Foundation Ca' GrandaOspedale Maggiore PoliclinicoMilanItaly
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17
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Schuler CF 4th, Volertas S, Khokhar D, Yuce H, Chen L, Baser O, Montejo JM, Akin C. Prevalence of mastocytosis and hymenoptera venom allergy in the United States. J Allergy Clin Immunol 2021:S0091-6749(21)00652-7. [PMID: 33895259 DOI: 10.1016/j.jaci.2021.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/26/2021] [Accepted: 04/07/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mastocytosis is a risk factor for hymenoptera venom anaphylaxis (HVA). Current guidelines recommend measuring tryptase in patients with HVA and that those with mastocytosis pursue lifelong venom immunotherapy (VIT). Available data on HVA and mastocytosis largely derive from European single-center studies, and the prevalence of HVA with and without mastocytosis in the United States is unknown. OBJECTIVE We sought to determine the prevalence of HVA and mastocytosis in the United States using an insurance claims database and evaluate the impact of mastocytosis on VIT in patients with HVA in a US cohort. METHODS The IBM Watson Database, consisting of insurance claims from approximately 27 million US patients in 2018, was queried to identify patients with HVA and/or mastocytosis. Furthermore, a retrospective study of 161 patients undergoing VIT between 2015 and 2018 at the University of Michigan was conducted. RESULTS In the IBM Watson Database, the prevalence of HVA was 167 per 100,000 (0.167%) and the prevalence of mastocytosis 10 per 100,000 (0.010%) overall and 97 per 100,000 (0.097%) among those with HVA. Mastocytosis showed a 9.7-fold increase among patients with HVA versus the general population. In the U-M cohort, 2.6% of patients with VIT had mastocytosis. Tryptase level did not correlate with venom reaction severity but was higher in patients with systemic VIT reactions. CONCLUSIONS We observed a lower US HVA prevalence than previously reported. Mastocytosis was more common in US patients with HVA, though at lower rates than previously reported. In patients with VIT there was no correlation between tryptase level and reaction severity.
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18
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Matysiak J, Matuszewska E, Kowalski ML, Kosiński SW, Smorawska-Sabanty E, Matysiak J. Association between Venom Immunotherapy and Changes in Serum Protein-Peptide Patterns. Vaccines (Basel) 2021; 9:249. [PMID: 33809001 DOI: 10.3390/vaccines9030249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 01/25/2023] Open
Abstract
Venom immunotherapy (VIT) is administered to allergic patients to reduce the risk of dangerous systemic reactions following an insect sting. To better understand the mechanism of this treatment and its impact on the human organism, we analysed serum proteomic patterns obtained at five time-points from Hymenoptera-venom-allergic patients undergoing VIT. For statistical analyses, patients were additionally divided into two groups (high responders and low responders) according to serum sIgG4 levels. VIT was found to be associated with changes in seven proteins: the fibrinogen alpha chain, complement C4-A, complement C3, filamin-B, kininogen-1, myosin-9 and inter-alpha-trypsin inhibitor heavy chain H1. The number of discriminative m/z (mass-to-charge ratio) features increased up to the 90th day of VIT, which may be associated with the development of immunity after the administration of increased venom doses. It may also suggest that during VIT, there may occur processes involved not only in protein synthesis but also in protein degradation (caused by proteolytic venom components). The results are consistent with measured serum sIgG4 levels, which increased from 2.04 mgA/I at baseline to 7.25 mgA/I at 90 days. Moreover, the major proteomic changes were detected separately in the high responder group. This may suggest that changes in protein–peptide profiles reflect the actual response to VIT.
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19
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Pecoraro L, Giovannini M, Mori F, Saretta F, Barni S, Castagnoli R, Arasi S, Mastrorilli C, Liotti L, Caminiti L, Novembre E. Immunotherapy for Hymenoptera venom allergy compared with real-life stings: Are we doing our best? Clin Exp Allergy 2021; 51:209-211. [PMID: 33617014 DOI: 10.1111/cea.13807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/11/2020] [Accepted: 12/06/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Luca Pecoraro
- Department of Medicine, University of Verona, Policlinico GB Rossi, Verona, Italy.,Pediatric Unit, ASST Mantua, Mantua, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
| | - Riccardo Castagnoli
- Department of Pediatrics, Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefania Arasi
- Predictive and Preventive Medicine Research Unit, Multifactorial and Systemic Diseases Research Area, Pediatric Allergy Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Carla Mastrorilli
- Pediatric Unit and Emergency, University Hospital Consortium Corporation Polyclinic of Bari, Pediatric Hospital Giovanni XXIII, Bari, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lucia Liotti
- Pediatric Unit, Senigallia Hospital, Senigallia, Italy
| | - Lucia Caminiti
- Department of Human Pathology in Adult and Development Age "Gaetano Barresi", Allergy Unit, Department of Pediatrics, AOU Policlinico Gaetano Martino, Messina, Italy
| | - Elio Novembre
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy
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Adelmeyer J, Pickert J, Pfützner W, Möbs C. Long-term impact of hymenoptera venom immunotherapy on clinical course, immune parameters, and psychosocial aspects. Allergol Select 2021; 5:57-66. [PMID: 33521509 DOI: 10.5414/ALX02175E] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Pałgan K, Żbikowska-Gotz M, Zacniewski R, Bartuzi Z. The effect of hymenoptera venom immunotherapy on neutrophils, interleukin 8 (IL-8) and interleukin 17 (IL-17). Int J Occup Med Environ Health 2020; 33:811-817. [PMID: 33029028 DOI: 10.13075/ijomeh.1896.01435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Venom immunotherapy (VIT) is an effective treatment method and is addressed to patients with a history of an anaphylactic reaction to Hymenoptera stings. However, the immunological mechanisms of protection have not been explained yet. The objective of this study was to analyze neutrophils, interleukin 8 (IL-8) and interleukin 17 (IL-17) before and after the initial phase of the immunotherapy. MATERIAL AND METHODS Overall, 40 individuals, including 20 wasp venom sensitized and 20 bee venom sensitized patients, were included in the study. The patients had had a history of severe allergic reactions type III and IV according to Mueller's classification. An ultra-rush VIT protocol was used in this study. The concentration of serum IL-8 and IL-17A was determined using the ELISA enzymatic method. RESULTS The authors demonstrated a significant rise in the IL-8 level after the immunotherapy, compared to baseline (14.9 vs. 24.7, p < 0.05). The rise in the neutrophils level was also noticeable but proved to be barely out of the range of statistical significance (4.3 vs. 5.0, p = 0.06). The shift in IL-17A was negligent and not statistically significant in the paired samples t-test (1.6 vs. 1.5, p = 0.34). CONCLUSIONS Venom immunotherapy induces neutrophils and IL-8 activity after 2 days. After the desensitization, the level of IL-17A did not change. Int J Occup Med Environ Health. 2020;33(6):811-7.
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Affiliation(s)
- Krzysztof Pałgan
- Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland (Department of Allergology, Clinical Immunology and Internal Diseases)
| | - Magdalena Żbikowska-Gotz
- Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland (Department of Allergology, Clinical Immunology and Internal Diseases)
| | - Robert Zacniewski
- Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland (Department of Allergology, Clinical Immunology and Internal Diseases)
| | - Zbigniew Bartuzi
- Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland (Department of Allergology, Clinical Immunology and Internal Diseases)
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Scarpone R, Oestmann E, Kraft M, Worm M. Good tolerability when switching from an aqueous ultra-rush Hymenoptera venom immunotherapy to a depot preparation. Allergy 2020; 75:1800-1802. [PMID: 32056216 DOI: 10.1111/all.14227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/30/2020] [Accepted: 02/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Roberta Scarpone
- Division of Allergy and Immunology Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Elsbeth Oestmann
- Division of Allergy and Immunology Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Magdalena Kraft
- Division of Allergy and Immunology Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Margitta Worm
- Division of Allergy and Immunology Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin Berlin Germany
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Jarkvist J, Salehi C, Akin C, Gülen T. Venom immunotherapy in patients with clonal mast cell disorders: IgG4 correlates with protection. Allergy 2020; 75:169-177. [PMID: 31306487 DOI: 10.1111/all.13980] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/09/2019] [Accepted: 05/26/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with clonal mast cell disorders (cMCD), systemic mastocytosis (SM) and monoclonal mast cell activation syndrome (MMAS), represent an increased risk for Hymenoptera venom anaphylaxis (HVA). Lifelong venom immunotherapy (VIT) is recommended; however, its efficacy and safety are controversial. Hence, we sought to evaluate the efficacy and safety of VIT in HVA patients with cMCD. METHODS A retrospective study was conducted among 46 patients with Vespula venom allergy who had experienced severe HVA, 32 cMCD (22 with SM and 10 with MMAS) and 14 controls. There were no differences between cMCD patients and controls in age (58 vs 66) and duration of VIT (47 vs 48 months), respectively. RESULTS During VIT, 11 (34%) cMCD patients experienced adverse reactions (ARs) (7% in controls), including 1 anaphylaxis. There were 23 re-stings in 17 (53%) patients during VIT. Of episodes, four (17%) presented with anaphylaxis, 14 (60%) presented with local reaction, and five (23%) were asymptomatic. In 11 episodes (48%), the patient did not take epinephrine, of these 8 (73%) presented with local reaction, and 3 (27%) were asymptomatic. Patient-based protection from anaphylaxis was 76% (4/17) in cMCD vs. 100% in controls during VIT. The venom-specific IgG4 concentrations increased during VIT (P < .001) although tryptase and IgE were unaltered. CONCLUSION Both safety and efficacy of VIT in cMCD patients were slightly reduced than controls. Severe ARs were rare. The elevated IgG4 levels may be a biomarker for efficacy of VIT in cMCD patients, as it correlates with protection from re-stings.
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Affiliation(s)
- Jesper Jarkvist
- Department of Respiratory Medicine and Allergy Karolinska University Hospital Huddinge Stockholm Sweden
- Immunology and Allergy Unit, Department of Medicine Solna Karolinska Institutet, and Karolinska University Hospital Stockholm Sweden
| | - Clara Salehi
- Department of Respiratory Medicine and Allergy Karolinska University Hospital Huddinge Stockholm Sweden
| | - Cem Akin
- Division of Allergy and Clinical Immunology, Department of Internal Medicine University of Michigan Health System Ann Arbor MI USA
| | - Theo Gülen
- Department of Respiratory Medicine and Allergy Karolinska University Hospital Huddinge Stockholm Sweden
- Immunology and Allergy Unit, Department of Medicine Solna Karolinska Institutet, and Karolinska University Hospital Stockholm Sweden
- Mastocytosis Center Karolinska Karolinska Institutet and Karolinska University Hospital Stockholm Sweden
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Sturm GJ, Arzt‐Gradwohl L, Varga EM. Medical Algorithms: Diagnosis and treatment of Hymenoptera venom allergy. Allergy 2019; 74:2016-2018. [PMID: 30972798 DOI: 10.1111/all.13817] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 11/30/2022]
Abstract
Diagnosis of Hymenoptera venom allergy (HVA) is straightforward in the majority of patients, but can be challenging in double positive and test negative patients. Test results sometimes can be confusing as patients with high skin test reactivity and high specific IgE (sIgE) levels are not at risk for severe systemic sting reactions (SSR), and conversely, patients with weakly positive or even negative tests can experience severe SSR. Venom immunotherapy (VIT) is safe, highly effective, and recommended in patients with moderate to severe SSR and in patients with SSR confined to generalized skin symptoms if quality of life is impaired.
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Affiliation(s)
- Gunter J. Sturm
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
- Allergy Outpatient Clinic Reumannplatz Vienna Austria
| | - Lisa Arzt‐Gradwohl
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
| | - Eva‐ M. Varga
- Mozartpraxis Paediatric Respiratory and Allergy Outpatient Practice Graz Austria
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Ridolo E, Pellicelli I, Kihlgren P, Nizi MC, Pucciarini F, Senna G, Incorvaia C. Immunotherapy and biologicals for the treatment of allergy to Hymenoptera stings. Expert Opin Biol Ther 2019; 19:919-925. [PMID: 31190572 DOI: 10.1080/14712598.2019.1632286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction: Venom immunotherapy (VIT) is an effective treatment for Hymenoptera venom allergy. The occurrence of severe reactions (SRs) to VIT, although infrequent, hampers the achievement of tolerance to insect stings. Risk factors for such reactions include allergy to honeybee venom, concomitant mast cell disorders, and the build-up phase of VIT. A role for omalizumab has come forward in recent years. Areas covered: This article reviews the available literature on the efficacy of omalizumab in preventing SRs and allowing the attainment of VIT maintenance doses. Pre- and co-treatments with omalizumab were evaluated, with positive overall results. Adding omalizumab to VIT in patients with SRs generally results in tolerance to VIT, thus restoring its precious preventive value. Expert opinion: VIT is effective for patients with Hymenoptera venom allergy and is recommended to prevent further (possibly fatal) reactions to stings. Omalizumab has shown efficacy in protecting patients from VIT-related SRs, particularly in those at high risk of SRs because of mast cell disorders and/or honeybee venom allergy. Notwithstanding, the accepted dose and time course of omalizumab for achieving tolerability and ensuring safety during VIT are not yet defined. In the future, other biologicals may play a role in preventing SRs during VIT.
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Affiliation(s)
- Erminia Ridolo
- a Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma , Parma , Italy
| | - Irene Pellicelli
- a Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma , Parma , Italy
| | - Paola Kihlgren
- a Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma , Parma , Italy
| | - Maria Cristina Nizi
- a Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma , Parma , Italy
| | - Francesco Pucciarini
- a Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma , Parma , Italy
| | - Gianenrico Senna
- b Asthma Center and Allergy Unit, University of Verona and General Hospital , Verona , Italy
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Pałgan K, Żbikowska-Götz M, Bartuzi Z. Expression of eosinophils, RANTES and IL-25 in the first phase of Hymenoptera venom immunotherapy. Postepy Dermatol Alergol 2020; 37:590-6. [PMID: 32994784 DOI: 10.5114/ada.2019.83655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Arzt L, Bokanovic D, Schrautzer C, Laipold K, Möbs C, Pfützner W, Herzog SA, Vollmann J, Reider N, Bohle B, Aberer W, Sturm GJ. Immunological differences between insect venom-allergic patients with and without immunotherapy and asymptomatically sensitized subjects. Allergy 2018; 73:1223-1231. [PMID: 29171032 DOI: 10.1111/all.13368] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Currently available tests are unable to distinguish between asymptomatic sensitization and clinically relevant Hymenoptera venom allergy. A reliable serological marker to monitor venom immunotherapy (VIT) does also not exist. Our aim was to find reliable serological markers to predict tolerance to bee and vespid stings. METHODS We included 77 asymptomatically sensitized subjects, 85 allergic patients with acute systemic sting reactions, and 61 allergic patients currently treated with VIT. Levels of sIgE and sIgG4 to bee and vespid venom, rApi m 1, and rVes v 5 were measured immediately after allergic sting reactions or before sting challenges and 4 weeks later. All sting challenges were tolerated. The inhibitory activity was determined using BAT inhibition and ELIFAB assay. RESULTS Median sIgG4 levels were 96-fold higher in VIT patients (P < .001) while sIgE/sIgG4 ratios were consistently lower (P < .001). The ELIFAB assay was paralleled by low sIgE/sIgG4 ratios in VIT patients, showing markedly higher allergen-blocking capacity (P < .001). An almost complete inhibition of the basophil response was seen in all patients treated with vespid venom, but not in those treated with bee venom. Four weeks after the sting, sIgE and sIgG4 levels were increased in allergic and asymptomatically sensitized patients, but not in VIT patients. CONCLUSION Immunological responses after stings varied in bee and vespid venom-allergic patients. In patients under VIT, sIgE and sIgG4 remained completely stable after sting challenges. Monitoring VIT efficacy was only possible in vespid venom allergy, and the sIgG4 threshold for rVes v 5 had the highest sensitivity to confirm tolerance. The BAT inhibition test was the most reliable tool to confirm tolerance on an individual basis.
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Affiliation(s)
- L. Arzt
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
| | - D. Bokanovic
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
| | - C. Schrautzer
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
| | - K. Laipold
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
| | - C. Möbs
- Clinical & Experimental Allergology, Department of Dermatology and Allergology Philipps‐University of Marburg Marburg Germany
| | - W. Pfützner
- Clinical & Experimental Allergology, Department of Dermatology and Allergology Philipps‐University of Marburg Marburg Germany
| | - S. A. Herzog
- Institute for Medical Informatics, Statistics and Documentation Medical University of Graz Graz Austria
| | - J. Vollmann
- Institute of Zoology University of Graz Graz Austria
| | - N. Reider
- Department of Dermatology, Venerology and Allergology Medical University of Innsbruck Innsbruck Austria
| | - B. Bohle
- Division of Cellular Allergology Institute of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
| | - W. Aberer
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
| | - G. J. Sturm
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
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Sturm GJ, Varga EM, Roberts G, Mosbech H, Bilò MB, Akdis CA, Antolín-Amérigo D, Cichocka-Jarosz E, Gawlik R, Jakob T, Kosnik M, Lange J, Mingomataj E, Mitsias DI, Ollert M, Oude Elberink JNG, Pfaar O, Pitsios C, Pravettoni V, Ruëff F, Sin BA, Agache I, Angier E, Arasi S, Calderón MA, Fernandez-Rivas M, Halken S, Jutel M, Lau S, Pajno GB, van Ree R, Ryan D, Spranger O, van Wijk RG, Dhami S, Zaman H, Sheikh A, Muraro A. EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy. Allergy 2018; 73:744-764. [PMID: 28748641 DOI: 10.1111/all.13262] [Citation(s) in RCA: 232] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2017] [Indexed: 01/27/2023]
Abstract
Hymenoptera venom allergy is a potentially life-threatening allergic reaction following a honeybee, vespid, or ant sting. Systemic-allergic sting reactions have been reported in up to 7.5% of adults and up to 3.4% of children. They can be mild and restricted to the skin or moderate to severe with a risk of life-threatening anaphylaxis. Patients should carry an emergency kit containing an adrenaline autoinjector, H1 -antihistamines, and corticosteroids depending on the severity of their previous sting reaction(s). The only treatment to prevent further systemic sting reactions is venom immunotherapy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Venom Immunotherapy as part of the EAACI Guidelines on Allergen Immunotherapy initiative. The guideline aims to provide evidence-based recommendations for the use of venom immunotherapy, has been informed by a formal systematic review and meta-analysis and produced using the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included representation from a range of stakeholders. Venom immunotherapy is indicated in venom-allergic children and adults to prevent further moderate-to-severe systemic sting reactions. Venom immunotherapy is also recommended in adults with only generalized skin reactions as it results in significant improvements in quality of life compared to carrying an adrenaline autoinjector. This guideline aims to give practical advice on performing venom immunotherapy. Key sections cover general considerations before initiating venom immunotherapy, evidence-based clinical recommendations, risk factors for adverse events and for relapse of systemic sting reaction, and a summary of gaps in the evidence.
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Pałgan K, Żbikowska-Götz M, Chrzaniecka E, Bartuzi Z. Venom immunotherapy and pregnancy. Postepy Dermatol Alergol 2018; 35:90-2. [PMID: 29599677 DOI: 10.5114/ada.2018.73168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 11/28/2016] [Indexed: 11/17/2022] Open
Abstract
Introductions The efficiency of venom immunotherapy (VIT) has been well documented by many studies. However, the most important for VIT is safety, particularly for a pregnant woman and a fetus. Aim To establish the influence of continuation of VIT on pregnant women and offspring. Material and methods The 6 women became pregnant during a specific immunotherapy. We retrospectively analyzed the influence of the immunotherapy on any complications for the pregnant women and their infants. Results Of the 6 patients who participated in this study, four had hyperemesis gravidarum, nausea, and heartburn, and two of them had gestational diabetes mellitus symptoms, typical of pregnancy. The observation indicated that VIT was safe for the pregnant women and their offspring. Conclusions The VIT is an appropriate therapeutic method for most patients with severe anaphylactic reactions after a hymenoptera sting. The observation indicated that VIT is safe for pregnant women and for their infants.
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Abstract
INTRODUCTION Allergy to Hymenoptera (Apis mellifera, Vespula species, Polistes species, Vespa crabro) venom can be safely and effectively treated by venom immunotherapy (VIT), which in the 40 years since its introduction has been able to prevent reactions to stings, and to treatment as well, though systemic reactions, occasionally severe, are possible. Areas covered: We reviewed the recent literature on VIT by searching in PubMed for the terms 'venom immunotherapy' and 'Hymenoptera venom immunotherapy' to highlight the current status of VIT and the likely development in the coming years. Expert commentary: VIT, provided the correct choice of the venom and adequate venom preparations and maintenance doses are used, is a treatment of great value in preventing systemic reactions to Hymenoptera stings. A 5-year duration ensures a prolonged tolerance to stings following VIT discontinuation, unless patients suffer from mastocytosis. In fact, due to reports of fatal reactions after stopping VIT, patients with mastocytosis, or with very severe reactions to stings, need an indefinite duration of treatment.
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Affiliation(s)
| | - Marina Mauro
- b Department of Clinical & Experimental Medicine , University of Parma , Parma , Italy
| | - Bruna L Gritti
- a Cardiac/Pulmonary Rehabilitation , ASST Pini/CTO , Milan , Italy
| | - Eleni Makri
- a Cardiac/Pulmonary Rehabilitation , ASST Pini/CTO , Milan , Italy
| | - Erminia Ridolo
- c Allergy Unit , Sant'Anna Hospital, ASST Lariana , Como , Italy
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Stretz E, Oppel EM, Räwer HC, Chatelain R, Mastnik S, Przybilla B, Ruëff F. Overcoming severe adverse reactions to venom immunotherapy using anti-IgE antibodies in combination with a high maintenance dose. Clin Exp Allergy 2017; 47:1631-1639. [PMID: 28802075 DOI: 10.1111/cea.12997] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/12/2017] [Accepted: 07/14/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND An omalizumab treatment and a high maintenance venom dose may both help to prevent recurrent systemic allergic reactions (SAR) to venom immunotherapy (VIT). The effectiveness of this combination therapy, however, is unclear. OBJECTIVE We wanted to explore the possibility whether a temporary treatment with the anti-IgE antibody omalizumab combined with a VIT using an elevated maintenance dose of >100 μg venom may establish a permanent tolerance of maintenance VIT. METHODS For this retrospective case series, we scoured our institutional data base for patients who had had an insect venom allergy, and in whom it had not been possible to continue VIT because of repeated unstoppable SAR during maintenance VIT. Patients were divided into those who had received the combination therapy (omalizumab group) and those who had not received omalizumab because its costs could not be covered (controls). Guided by the total IgE level and by body weight, omalizumab had been given subcutaneously 5, 3 and 1 weeks before VIT had been restarted. Three to 6 months after an elevated maintenance dose (200-300 μg venom) had been reached, omalizumab had been stopped. RESULTS Between 2006 and 2011, 15 patients had qualified for an off-label use of omalizumab: 10 patients had received the combination therapy, and 5 patients had remained without such a therapy. The combination therapy leads to a durable tolerance of VIT in all patients even after omalizumab had been discontinued (median of follow-up time 5.8 years, IQR 2.7-8.6 years). Sting challenge tests were tolerated by all of the re-stung omalizumab patients (n = 8). In all controls, VIT had to be stopped permanently due to repeated SARs (P < .001 vs omalizumab group). CONCLUSIONS AND CLINICAL RELEVANCE Combining a temporary omalizumab therapy with an elevated maintenance dose seems a promising approach to achieve a tolerance of treatment in patients with a recurrent SAR to VIT.
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Affiliation(s)
- E Stretz
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Germany
| | - E M Oppel
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Germany
| | - H-C Räwer
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Germany
| | - R Chatelain
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Germany
| | - S Mastnik
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Germany
| | - B Przybilla
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Germany
| | - F Ruëff
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München, Germany
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Blank S, Etzold S, Darsow U, Schiener M, Eberlein B, Russkamp D, Wolf S, Graessel A, Biedermann T, Ollert M, Schmidt-Weber CB. Component-resolved evaluation of the content of major allergens in therapeutic extracts for specific immunotherapy of honeybee venom allergy. Hum Vaccin Immunother 2017; 13:2482-2489. [PMID: 28494206 PMCID: PMC5647995 DOI: 10.1080/21645515.2017.1323603] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Allergen-specific immunotherapy is the only curative treatment of honeybee venom (HBV) allergy, which is able to protect against further anaphylactic sting reactions. Recent analyses on a molecular level have demonstrated that HBV represents a complex allergen source that contains more relevant major allergens than formerly anticipated. Moreover, allergic patients show very diverse sensitization profiles with the different allergens. HBV-specific immunotherapy is conducted with HBV extracts which are derived from pure venom. The allergen content of these therapeutic extracts might differ due to natural variations of the source material or different down-stream processing strategies of the manufacturers. Since variations of the allergen content of therapeutic HBV extracts might be associated with therapeutic failure, we adressed the component-resolved allergen composition of different therapeutic grade HBV extracts which are approved for immunotherapy in numerous countries. The extracts were analyzed for their content of the major allergens Api m 1, Api m 2, Api m 3, Api m 5 and Api m 10. Using allergen-specific antibodies we were able to demonstrate the underrepresentation of relevant major allergens such as Api m 3, Api m 5 and Api m 10 in particular therapeutic extracts. Taken together, standardization of therapeutic extracts by determination of the total allergenic potency might imply the intrinsic pitfall of losing information about particular major allergens. Moreover, the variable allergen composition of different therapeutic HBV extracts might have an impact on therapy outcome and the clinical management of HBV-allergic patients with specific IgE to particular allergens.
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Affiliation(s)
- Simon Blank
- a Center of Allergy and Environment (ZAUM) , Technical University of Munich and Helmholtz Center Munich, Member of the German Center of Lung Research (DZL) , Munich , Germany
| | - Stefanie Etzold
- a Center of Allergy and Environment (ZAUM) , Technical University of Munich and Helmholtz Center Munich, Member of the German Center of Lung Research (DZL) , Munich , Germany
| | - Ulf Darsow
- b Department of Dermatology and Allergy Biederstein , Technical University of Munich , Munich , Germany
| | - Maximilian Schiener
- a Center of Allergy and Environment (ZAUM) , Technical University of Munich and Helmholtz Center Munich, Member of the German Center of Lung Research (DZL) , Munich , Germany
| | - Bernadette Eberlein
- b Department of Dermatology and Allergy Biederstein , Technical University of Munich , Munich , Germany
| | - Dennis Russkamp
- a Center of Allergy and Environment (ZAUM) , Technical University of Munich and Helmholtz Center Munich, Member of the German Center of Lung Research (DZL) , Munich , Germany
| | - Sara Wolf
- c Institute of Biochemistry and Molecular Biology, University of Hamburg , Hamburg , Germany
| | - Anke Graessel
- a Center of Allergy and Environment (ZAUM) , Technical University of Munich and Helmholtz Center Munich, Member of the German Center of Lung Research (DZL) , Munich , Germany
| | - Tilo Biedermann
- b Department of Dermatology and Allergy Biederstein , Technical University of Munich , Munich , Germany
| | - Markus Ollert
- d Department of Infection and Immunity , Luxembourg Institute of Health (LIH) , Esch-sur-Alzette , Luxembourg.,e Department of Dermatology and Allergy Center , Odense Research Center for Anaphylaxis, University of Southern Denmark , Odense C , Denmark
| | - Carsten B Schmidt-Weber
- a Center of Allergy and Environment (ZAUM) , Technical University of Munich and Helmholtz Center Munich, Member of the German Center of Lung Research (DZL) , Munich , Germany
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Kołaczek A, Skorupa D, Antczak-Marczak M, Kuna P, Kupczyk M. Safety and efficacy of venom immunotherapy: a real life study. Postepy Dermatol Alergol 2017; 34:159-67. [PMID: 28507496 DOI: 10.5114/ada.2017.67082] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 03/10/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction Venom immunotherapy (VIT) is recommended as the first-line treatment for patients allergic to Hymenoptera venom. Aim To analyze the safety and efficacy of VIT in a real life setting. Material and methods One hundred and eighty patients undergoing VIT were studied to evaluate the safety, efficacy, incidence and nature of symptoms after field stings and adverse reactions to VIT. Results Significantly more patients were allergic to wasp than bee venom (146 vs. 34, p < 0.0001). Early and late side effects were more common during the maintenance (48 patients, 26.7%) than during the induction of VIT (32 patients, 17.8%), were more frequent in patients allergic to bees, and were not associated with angiotensin convertase inhibitors (ACEi) or β-adrenergic antagonists use. Systemic reactions were observed in 4 individuals on wasp VIT (2.7%) and in 6 patients allergic to bees (17.65%). The VIT was efficacious as most patients reported no reactions (50%) or reported only mild local reactions (43.75%) to field stings. The decrease in sIgE at completion of VIT correlated with the dose of vaccine received (r = 0.53, p = 0.004). Beekeeping (RR = 29.54, p < 0.0001) and female sex (RR = 1.27, p = 0.033) were associated with a higher risk of venom allergy. Conclusions Venom immunotherapy is highly efficacious and safe as most of the adverse events during the induction and maintenance phase are mild and local. Side effects of VIT are more common in subjects on bee VIT. Beekeeping and female sex are associated with a higher risk of allergy to Hymenoptera venom.
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Nowak N, Bazan-Socha S, Pulka G, Pełka K, Latra P. Evaluation of the quality of life in subjects with a history of severe anaphylactic reaction to the Hymenoptera venom. Pneumonol Alergol Pol 2017; 83:352-8. [PMID: 26378996 DOI: 10.5603/piap.2015.0057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Sensitization to the Hymenoptera venom is one of the main causes of anaphylaxis in Poland. Venom immunotherapy is the only effective treatment in such cases. Comprehensive patient care includes also education. The aim of our study was to assess the state of knowledge and to evaluate the quality of life and the anxiety level in patients allergic to the Hymenoptera venom after anaphylactic reaction. MATERIAL AND METHODS The survey was carried out in the period of the insects flight in 61 adult subjects (35 wasp and 26 bee allergic), using a validated Vespid Allergy Quality of Life Questionnaire (VQLQ), Hospital Anxiety and Depression Scale, and subjective assessment of anxiety level. The majority of respondents received venom immunotherapy. RESULTS Sensitized to the wasp venom had significantly impaired quality of life (VQLQ score) as compared to the bee venom allergic (p = 0.014). The intensity of anxiety decreased with the duration of immunotherapy (p = 0.01). The majority of subjects knew how to recognize and treat anaphylaxis, but only 8% employed an identification card and about 50% implemented rules of the pre-exposition prophylaxis. CONCLUSIONS History of a severe anaphylaxis to the Hymenoptera venom affected the quality of life. Venom immunotherapy reduced anxiety. We hope that presented surveys and their results might be useful in qualifying for immunotherapy in clinically uncertain cases.
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Affiliation(s)
- Natalia Nowak
- University Hospital, Allergy and Clinical Immunology Department, Krakow, Poland.
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Nittner-Marszalska M, Liebhart J, Dor-Wojnarowska A. Sex-related clinical aspects in insect venom anaphylaxis. Int J Immunopathol Pharmacol 2015; 28:187-93. [PMID: 26078379 DOI: 10.1177/0394632015586143] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/10/2015] [Indexed: 11/16/2022] Open
Abstract
Experimental studies, epidemiological data, and clinical observations suggest that the gender factor is involved in the development and manifestation of IgE-dependent allergic diseases. We intend to answer the question if sex-related factors may play a role in Hymenoptera venom allergy (HVA). In the majority of recent studies the frequency of HVA symptoms with respect to both LL and SYS reactions is similar for men and women, while proven sensitization to insect venom is less frequent in women. Studies assessing clinical reactivity in HVA indicate that male sex and vespid venom allergy are factors increasing the risk of severe allergic reactions. Regarding the risk of adverse events associated with gender in the course of venom immunotherapy (VIT), the results of two large EAACI multicenter studies are discordant. In the first study, women showed increased risk of VIT adverse events. In the latter, systemic allergic side effects were not associated with gender. Despite theoretical premises and certain clinical observations indicating an important role of estrogens in allergic diseases, their influence on stinging insects' venom hypersensitivity is not unequivocal and remains still open. Further studies on the safety of VIT in females seem to be advisable.
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Affiliation(s)
| | - Jerzy Liebhart
- Department of Internal Diseases, Geriatrics and Allergology Medical University, Wroclaw, Poland
| | - Anna Dor-Wojnarowska
- Department of Internal Diseases, Geriatrics and Allergology Medical University, Wroclaw, Poland
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Rael E, Lockey RF. Optimal duration of allergen immunotherapy. J Allergy Clin Immunol 2014; 134:1218-9.e2. [PMID: 25439231 DOI: 10.1016/j.jaci.2014.08.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/11/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Efren Rael
- Section of Allergy, Asthma & Immunology, Division of Pulmonary, Allergy, and Critical Care, Department of Internal Medicine, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pa.
| | - Richard F Lockey
- Division of Allergy and Immunology, The University of South Florida College of Medicine, Tampa, Fla
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Pesek RD, Lockey RF. Management of insect sting hypersensitivity: an update. Allergy Asthma Immunol Res 2013; 5:129-37. [PMID: 23638310 PMCID: PMC3636446 DOI: 10.4168/aair.2013.5.3.129] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/18/2012] [Accepted: 09/26/2012] [Indexed: 11/20/2022]
Abstract
Reactions to Hymenoptera insect stings are common. While most are self-limited, some induce systemic allergic reactions or anaphylaxis. Prompt recognition, diagnosis, and treatment of these reactions are important for improving quality-of-life and reducing the risk of future sting reactions. This review summarizes the current recommendations to diagnose and treat Hymenoptera sting induced allergic reactions and highlights considerations for various populations throughout the world.
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Affiliation(s)
- Robert D Pesek
- Division of Allergy and Immunology, Arkansas Children's Hospital, Little Rock, AR, USA
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Cichocka-Jarosz E, Diwakar L, Brzyski P, Tobiasz-Adamczyk B, Lis G, Pietrzyk JJ. Congruence of the current practices in Hymenoptera venom allergic patients in Poland with EAACI guidelines. Arch Med Sci 2011; 7:832-9. [PMID: 22291828 PMCID: PMC3258816 DOI: 10.5114/aoms.2011.25558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 10/05/2010] [Accepted: 10/26/2010] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Venom immunotherapy (VIT) practice is the definitive treatment for patients with potentially fatal allergic reactions to Hymenoptera stings. The aim is assesing compliance of VIT practice in Poland with the current European Academy of Allergy and Clinical Immunology (EAACI) guidance. MATERIAL AND METHODS A multicentre study was carried out using a structured questionnaire which was sent by post to all VIT practitioners in Poland. Some questionnaire items were altered, in comparison to original version by adding additional answer options or alowing multiple answer option. The response rate was 100%. The obtained results were compared with the published EAACI guidelines. RESULTS Twenty-six Polish centres took part in the survey. SSIgE and skin prick tests (SPT) are together used as the first line of investigation, whereas confirmatory intradermal tests (IDT) are applied in half of centres. Only a few centres measure baseline serum tryptase levels. The ultra-rush protocol is preferred. Antihistamine pre-medication is routinely practiced. A target dose equal to 100 µg is used in most centres. A 6-week interval between booster doses is the most frequent. Five years is considered as an optimal VIT duration. Before the VIT completion, SSIgE is evaluated in fifty percent of centres, whereas sting challenge is considered by half of responders. CONCLUSIONS There are some differences between current practice in Poland and the EAACI recommendations, indicating areas requiring better compliance. Comparision between Poland and the United Kingdom revealed that health service organization and health care funding may play a major role in the provision of allergy services. This may affect the extent to which international guidance may be applied in individual countries. It is worth considering conducting the same survey in other European countries.
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Affiliation(s)
- Ewa Cichocka-Jarosz
- Department of Pediatrics, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow, Poland
- Corresponding author: Ewa Cichocka-Jarosz MD, PhD, Department of Pediatrics Polish-American Children's Hospital, Jagiellonian University Medical College, 265 Wielicka, 30-663 Krakow, Poland, Phone: 48 12 658 20 11, ext. 1655, Fax: 48 12 658 44 46. E-mail:
| | - Lavanya Diwakar
- Department of Allergy and Immunology, Heartlands Hospital, Birmingham, United Kingdom
| | - Piotr Brzyski
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Beata Tobiasz-Adamczyk
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Grzegorz Lis
- Department of Pediatrics, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek J. Pietrzyk
- Department of Pediatrics, Polish-American Children's Hospital, Jagiellonian University Medical College, Krakow, Poland
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