Recombinant Hymenoptera venom allergens.

Abstract

Hymenoptera venoms, instead of the previously used whole body extracts, were introduced in the late 1970s for the diagnosis and treatment of IgE-mediated allergic reactions to stings by insects of the order Hymenoptera, such as honey bees and vespids (1, 2). Insect venom allergy is often considered as a model for IgE-mediated allergy: Diagnostic tests (skin tests and radioallergosorbant assays, RAST) are thought to be reliable, and specific immunotherapy with venoms is claimed to be safe and highly effective. However on closer looks the specificity of the main diagnostic tests (prick tests or intracutaneous skin tests with insect venom extracts, and tests for venom-specific serum IgE antibodies) is far from perfect. Up to 20% of individuals with no history of systemic sting reactions have positive tests. On the other hand only 30–50% of those with positive tests will react to a subsequent sting by the respective insect (3). According to a sting provocation test during venom immunotherapy around 95% of patients allergic to vespid stings are completely protected and do not develop any generalized allergic symptoms, while the complete protection rate achieved for those allergic to honey bee venom is only 80–90% (3, 4). Systemic allergic side-effects to immunotherapy injections may occur in 20–40% of patients during immunotherapy with honey bee venom and 5–10% during immunotherapy with vespid venoms (4). There is therefore considerable potential for improvement of both diagnosis and immunotherapy of Hymenoptera venom allergy. Thanks to modern molecular biology technology, recombinant venom allergens are available today and offer several promising approaches to achieve such an improvement. Expression of various recombinant allergens from Hymenoptera venoms