Abstract
Allergic reactions to stings of Hymenoptera species may be severe and are potentially fatal deviations of the immunological response observed in healthy individuals. However, venom-specific immunotherapy (VIT) is an immunomodulatory approach able to cure venom allergy in the majority of affected patients. An appropriate therapeutic intervention and the efficacy of VIT not only depend on a conclusive diagnosis, but might also be influenced by the patient-specific manifestation of the disease. As with other diseases, it should be borne in mind that there are different endotypes and phenotypes of venom allergy, each of which require a patient-tailored disease management and treatment scheme. Reviewed here are different endotypes of sting reactions such as IgE-mediated allergy, asymptomatic sensitization or a simultaneous presence of venom allergy and mast cell disorders including particular considerations for diagnosis and therapy. Additionally, phenotypical manifestations of venom allergy, as e.g. differences in age of onset and disease severity, multiple sensitization or patients unsusceptible to therapy, are described. Moreover, biomarkers and diagnostic strategies that might reflect the immunological status of the patient and their value for therapeutic guidance are discussed. Taken together, the increasing knowledge of different disease manifestations in venom hypersensitivity and the growing availability of diagnostic tools open new options for the classification of venom allergy and, hence, for personalized medical approaches and precision medicine in Hymenoptera venom allergy.
Highlights
Hymenoptera venom allergy (HVA) is one of the most serious IgE-mediated hypersensitivity reactions due to the high risk of severe and even fatal anaphylaxis
Diagnostic algorithms to discriminate between honeybee venom (HBV) and vespid venom and yellow jacket venom (YJV) and Polistes dominula venom (PDV) allergy are given in Figures 3A, B, respectively
After the relevance of additional HBV allergens was demonstrated, these became available for routine diagnosis and it was shown that a combination of the allergens Api m 1, Api m 2, Api m 3, Api m 4, Api m 5, and Api m 10 leads to a diagnostic sensitivity of 94.4% in a population of HBV-allergic patients [103]
Summary
Hymenoptera venom allergy (HVA) is one of the most serious IgE-mediated hypersensitivity reactions due to the high risk of severe and even fatal anaphylaxis. In Northern and Central Europe, the most common elicitors of venom allergy are honeybees (Apis mellifera) and yellow jackets (Vespula spp.). In addition to honeybees and yellow jackets, paper wasp (Polistes spp.) venom allergy is of relevance in Southern Europe and Northern America. The estimated number of annual mortalities due to insect stinginduced anaphylaxis ranges from 0.03 to 0.45 per one million inhabitants [12] This number could be underestimated as many fatal reactions following insect stings may remain undetected [13]. The classification of allergic reactions to Hymenoptera venoms into different endotypes and phenotypes, which can be assigned through various biomarkers and diagnostic strategies (Figure 2), enables individual risk stratification for the patients and personalized therapeutic strategies
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