The culprit insect but not severity of allergic reactions to bee and wasp venom can be determined by molecular diagnosis.

Pia Gattinger,Irene Mittermann,Lampros Kalogiros,Natalija Novak,Christian Lupinek,Mira Silar,Peter Korosec,Mihaela Zidarn,Christine Koessler,Rudolf Valenta,Edda Fiebiger

doi:10.1371/journal.pone.0199250

Abstract

BackgroundAllergy to bee and wasp venom can lead to life-threatening systemic reactions. The identification of the culprit species is important for allergen-specific immunotherapy.ObjectivesTo determine a panel of recombinant bee and wasp allergens which is suitable for the identification of bee or wasp as culprit allergen sources and to search for molecular surrogates of clinical severity of sting reactions.MethodsSera from eighty-seven patients with a detailed documentation of their severity of sting reaction (Mueller grade) and who had been subjected to titrated skin testing with bee and wasp venom were analyzed for bee and wasp-specific IgE levels by ImmunoCAPTM. IgE-reactivity testing was performed using a comprehensive panel of recombinant bee and wasp venom allergens (rApi m 1, 2, 3, 4, 5 and 10; rVes v 1 and 5) by ISAC chip technology, ImmunoCAP and ELISA. IgG4 antibodies to rApi m 1 and rVes v 5 were determined by ELISA and IgE/IgG4 ratios were calculated. Results from skin testing, IgE serology and IgE/IgG4 ratios were compared with severity of sting reactions.ResultsThe panel of rApi m 1, rApi m 10, rVes v 1 and rVes v 5 allowed identification of the culprit venom in all but two of the 87 patients with good agreement to skin testing. Severities of sting reactions were not associated with results obtained by skin testing, venom-specific IgE levels or molecular diagnosis. Severe sting reactions were observed in patients showing < 1 ISU and < 2kUA/L of IgE to Api m 1 and/or Ves v 5.ConclusionWe identified a minimal panel of recombinant bee and wasp allergens for molecular diagnosis which may permit identification of bee and/or wasp as culprit insect in venom-sensitized subjects. The severity of sting reactions was not associated with parameters obtained by molecular diagnosis.

Highlights

Systemic allergic reactions to insect venoms affect the skin, the respiratory and gastro-intestinal tract as well as the cardiovascular system and are often life-threatening
We identified a minimal panel of recombinant bee and wasp allergens for molecular diagnosis which may permit identification of bee and/or wasp as culprit insect in venom-sensitized subjects
The severity of sting reactions was not associated with parameters obtained by molecular diagnosis

Summary

Introduction

Systemic allergic reactions to insect venoms affect the skin, the respiratory and gastro-intestinal tract as well as the cardiovascular system and are often life-threatening. Several new bee and wasp allergens have been identified [14, 15] While their contribution to increase the diagnostic sensitivity of bee and wasp venom allergy has been investigated, much less is known about their value for identifying the culprit sensitizing venom in double-sensitized patients [16,17]. Another important question is whether it is possible to establish surrogate markers similar as in the field of food allergy which allow prediction of the severity of allergic reactions on the basis of allergen-specific sensitivity, allergen-specific IgE levels and/or intensity of IgE recognition of certain marker allergens [18]. The identification of the culprit species is important for allergen-specific immunotherapy

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