Abstract
BackgroundThe high rate of asymptomatic sensitization to Hymenoptera venom, difficulty in correctly identifying Hymenoptera and loss of sensitization over time make an accurate diagnosis of Hymenoptera venom allergy challenging. Although routine diagnostic tests encompassing skin tests and the detection of venom-specific IgE antibodies with whole venom preparations are reliable, they offer insufficient precision in the case of double sensitized patients or in those with a history of sting anaphylaxis, in whom sensitization cannot be proven or only to the presumably wrong venom.MethodsSystematic literature research and review of current concepts of diagnostic testing in Hymenoptera venom allergy.Results and discussionImprovements in diagnostic accuracy over recent years have mainly been due to the increasing use of molecular allergy diagnostics. Detection of specific IgE antibodies to marker and cross-reactive venom allergens improves the discrimination between genuine sensitization and cross-reactivity, and this provides a better rationale for prescribing venom immunotherapy. The basophil activation test has also increased diagnostic accuracy by reducing the number of Hymenoptera venom sensitizations overlooked with routine tests. This paper reviews current concepts of diagnostic testing in Hymenoptera venom allergy and suggests fields for further development.
Highlights
Hymenoptera venom allergy (HVA) is one of the most common causes of anaphylaxis in adults and is frequently associated with severe anaphylaxis [1, 2]
Bumblebees (Bombus) and hornets (Vespa) are rarely involved in sting reactions and allergy is usually due to crossreactivity to honeybee venom (HBV) and yellow jacket venom (YJV), respectively
In this paper we review the diagnostic tests currently available for the investigation of HVA, their benefits and limitations, and suggest areas for further improvement
Summary
Hymenoptera venom allergy (HVA) is one of the most common causes of anaphylaxis in adults and is frequently associated with severe anaphylaxis [1, 2]. Between 45 and 50% of Hymenoptera venom allergic patients display double sensitization to both HBV and YJV on diagnostic testing with skin tests and venom sIgE. No marker allergens specific to Polistes or Dolichovespula have been identified so that patients primarily sensitized to these Hymenoptera venoms will be misdiagnosed as allergic to yellow jacket but subsequently inadequately protected by yellow jacket VIT [43].
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