Abstract
Severe systemic reactions to hymenoptera stings are a significant problem world-wide. Skin test reactivity and specific IgE measurement by RAST correlate with the risk of allergic reactions to stings. Desensitisation to venom preparations is highly effective in protecting patients against systemic reactions. I have developed an ELIZA assay which is capable of detecting bee-venom specific IgG subclass antibodies. The assay has < 2% cross-reactivity for both isotype and unrelated antigen. It is capable of measuring antibody in the ng/ml range. Blanks and negative controls consistently give ODs < 0.1 unit. Normal individuals and patients with proven allergy to bee-stings (history, skin tests and RAST) have low levels of IgG subclass specific antibodies. After desensitisation there is a rapid increase in IgG4 antibodies with a smaller increase in IgG1-3 antivenom antibodies. In most of these patients RAST and skin tests remain positive. A study of bee-keepers showed very high levels of IgG4 antibee venom antibodies. Interestingly many bee-keepers also had positive RAST tests to bee venom. These results suggest that bee venom specific IgG4 antibodies may be the best predictor of protection against systemic bee sting reactions in patients undergoing desensitisation.
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