Comparing the ability of molecular diagnosis and CAP-inhibition in identifying the really causative venom in patients with positive tests to Vespula and Polistes species.

Eleonora Savi,Elena Makri,Valerio Pravettoni,Silvia Peveri,Cristoforo Incorvaia

doi:10.1186/s12948-016-0040-5

Abstract

BackgroundCross-reactivity among Hymenoptera venoms is an important issue when prescribing venom immunotherapy (VIT). Using all venoms eliciting a positive response results in treatment excess and unjustified cost increase. The first in vitro method that helped to identify the really causative venom was RAST-inhibition, but in latest years also molecular allergy (MA) diagnostics, that detects specific sIgE to single venom allergens, was introduced. We compared the two methods in patients with double sensitization to Vespula spp. and Polistes spp.MethodsFifty-four patients with anaphylactic reactions to Hymenoptera stings and positive results to skin tests and sIgE measurement with whole venom from Vespula spp. and Polistes dominula were included in the study. Sera from all patients were analyzed by CAP-inhibition (Thermo Fisher Scientific, Uppsala, Sweden) and MA diagnostics with recombinant Ves v 1, Ves v 5 and Pol d 5.ResultsBy the data obtained from MA technique, VIT would have been prescribed to 7 patients for Polistes, to 6 for Vespula, and to 41 for both venoms. With the data from CAP inhibition, it would have been a prescription to 15 patients for Polistes, to 28 for Vespula, and to 11 for both venoms. A good concordance between the results of MA and CAP-inhibition was found only when the value in kU/l of Ves v 5 were about twice those of Pol d 5, and vice versa.ConclusionsThese findings suggest that in the choice of the venom to be used for VIT CAP-inhibition remains a pivotal tool, because the significance of in vitro inhibition is definite and provides a diagnostic importance higher than MA in patients with positive tests to both Vespula and Polistes spp.

Highlights

Cross-reactivity among Hymenoptera venoms is an important issue when prescribing venom immunotherapy (VIT)
Savi et al Clin Mol Allergy (2016) 14:3 positive Vespula- and Polistes-reactive IgE in the skin and/or serum were identified as candidates for exclusion of Polistes from immunotherapy because their IgE anti-Polistes was more than 95 % cross-inhibitable with Vespula venom [4]
In 2012, a molecular allergy (MA)-based study on patients with such kind of sensitization found that Polistes and Vespula were the culprit insect in 49 and 20 %, respectively [12], but this was in contrast with the general knowledge on the importance of these species in Hymenoptera venom allergy (HVA) [13]

Summary

Introduction

Cross-reactivity among Hymenoptera venoms is an important issue when prescribing venom immunotherapy (VIT). Stings by Hymenoptera, including honeybees (Apis mellifera), yellow jackets (Vespula species), paper wasps (Polistes species), and hornets (Dolicho vespula, Vespa crabro) cause systemic allergic reactions in 1–5 % of the population in Europe and North America [1]. The mechanism of these reactions is an IgE-mediated sensitization to proteins of the venoms injected with the stings, Savi et al Clin Mol Allergy (2016) 14:3 positive Vespula- and Polistes-reactive IgE in the skin and/or serum were identified as candidates for exclusion of Polistes from immunotherapy because their IgE anti-Polistes was more than 95 % cross-inhibitable with Vespula venom [4]. In 2012, a MA-based study on patients with such kind of sensitization found that Polistes and Vespula were the culprit insect in 49 and 20 %, respectively [12], but this was in contrast with the general knowledge on the importance of these species in HVA [13]

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