Imported Fire Ant Whole-body Extract Research Articles

Imported fire ant rush desensitization using omalizumab and a premedication regimen

Imported fire ant (IFA) whole-body extract (WBE) rush immunotherapy (RIT) is a safe and effective means to reach the recommended maintenance dose of 0.5 mL (1:100 wt/vol). 1 Tankersley M.S. Walker R.L. Butler W.K. Hagan L.L. Napoli D.C. Freeman T.M. Safety and efficacy of an imported fire ant rush immunotherapy protocol with and without prophylactic treatment. J Allergy Clin Immunol. 2002; 109: 556-562 Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar , 2 Golden D.B. Moffitt J. Nicklas R.A. et al. Sting insect hypersensitivity: a practice parameter update 2011. J Allergy Clin Immunol. 2011; 127: 852-854.e23 Abstract Full Text Full Text PDF PubMed Scopus (201) Google Scholar Omalizumab, an anti-IgE monoclonal antibody, has been reported as a useful adjunct to venom immunotherapy (IT) protocols. 3 da Silva E.N. Randall K.L. Omalizumab mitigates anaphylaxis during ultrarush honey bee venom immunotherapy in monoclonal mast cell activation syndrome. J Allergy Clin Immunol Pract. 2013; 1: 687-688 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar , 4 Galera C. Soohun N. Zankar N. Caimmi S. Gallen C. Demoly P. Severe anaphylaxis to bee venom immunotherapy: efficacy of pretreatment and concurrent treatment with omalizumab. J Investig Allergol Clin Immunol. 2009; 19: 225-229 PubMed Google Scholar , 5 Palgan K. Bartuzi Z. Gotz-Zbikowska M. Treatment with a combination of omalizumab and specific immunotherapy for severe anaphylaxis after a wasp sting. Int J Immunopathol Pharmacol. 2014; 1: 109-112 Google Scholar We report the case of a patient who was unable to reach the recommended maintenance dose on a conventional IFA WBE IT buildup schedule because of repeated systemic reactions. After omalizumab therapy was initiated, IFA WBE RIT with antihistamine and corticosteroid premedication was successfully completed.

A 1-day imported fire ant rush immunotherapy schedule with and without premedication

BackgroundRush immunotherapy (RIT) schedules can expedite protection in individuals sensitive to imported fire ant (IFA) stings. ObjectiveTo evaluate the safety and efficacy of 1-day RIT with IFA whole body extract (WBE) and determine the benefit of premedication with antihistamines and prednisone. MethodsPatients with systemic reactions to IFAs and evidence of specific IgE by skin test or serologic test started a 1-day RIT protocol without premedication. The 1-day RIT protocol consisted of a total of 10 injections every 30 to 60 minutes to achieve a 0.3-mL 1:100 (wt/vol) dose. A higher systemic reaction rate (SRR) prompted protocol revision to include a 3-day course of oral 20 mg of prednisone twice daily, 150 mg of ranitidine, and 10 mg of loratadine started 2 days before the 1-day RIT. Patients returned on days 8 and 15 to receive a 0.5 mL 1:100 (wt/vol) maintenance injection. The effectiveness of the RIT was evaluated with a sting challenge on approximately day 22. ResultsEighty of the 96 patients enrolled initiated the 1-day RIT. The first nonpremedicated group exhibited a SRR of 24.3% (9 of 37 patients), whereas the revised premedicated group had a SRR of 9.5% (4 of 42 patients; P = .07). The most severe reaction during RIT included dizziness, angioedema, and urticaria. Sting challenges on 53 patients resulted in 1 mild rhinitis reaction (efficacy, 98.1%). ConclusionOne-day RIT with IFA WBE for IFA hypersensitivity is efficacious. Although there was a trend with premedications to reduce SRRs during the RIT, safety data with premedication require confirmation in a larger trial.

Successful administration of a 1-day imported fire ant rush immunotherapy protocol

Young children with a history of systemic reactions to imported fire ant (IFA) stings are at substantial risk of recurrent stings because of their maturational inability to practice appropriate avoidance techniques. To present 3 cases in which patients 36 months or younger completed a 1-day rush immunotherapy (RIT) protocol with IFA whole-body extract (WBE). The 1-day RIT protocol used for these patients was modified from the Wilford Hall 2-day rush protocol previously published. A 1:1 vol/vol maintenance vial consisted of 1 mL of IFA WBE and 9 mL of human serum albumin diluent in a 10-mL vial. All 3 patients had positive intradermal skin test results to IFA WBE. No systemic reactions occurred during the 1-day RIT. This case series provides data with which we can begin to assess the efficacy and safety of a 1-day IFA RIT protocol for the prevention of anaphylaxis in IFA allergic children. Further studies with larger numbers of patients are needed to confirm the findings.

The Effect of Imported Fire Ant Whole-Body Extract on the Degradation of Timothy, Ragweed, Cat, and House Dust Mite Allergens

The Effect of Imported Fire Ant Whole-Body Extract on the Degradation of Timothy, Ragweed, Cat, and House Dust Mite Allergens

Effect of imported fire ant extract on the degradation of mountain cedar pollen allergen

Dust mite, cockroach, and mold extracts have been shown to contain proteases capable of degrading the proteins in other extracts. Loss of potency of allergens has been reported in mixtures containing cockroach and fungal extracts. Fire ant venoms consist of 90% to 95% n-alkyl and n-alkenyl piperidine alkaloids, which are not allergenic. No studies are available addressing the mixture of imported fire ant (IFA) whole-body extract with other allergens or the presence of proteolytic activity in the venom extract. To evaluate the stability of mountain cedar pollen extract mixed with IFA whole-body extract and to qualitatively analyze the extract mixture for degradation of mountain cedar protein. One milliliter each of mountain cedar and IFA whole-body extracts at a concentration of 500 microg/mL were combined and stored at 4 degrees C for 1, 3, 6, 15, 30, 60, 90, and 180 days. Separate mixtures of 1 mL of mountain cedar and IFA with 1 mL of human serum albumin were used as controls. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis was performed, and protein bands were qualitatively analyzed for degradation. We detected 3 distinct IFA protein bands and 1 mountain cedar protein band. With respect to these bands, no protein degradation was observed during 6 months of study in the extract mixture compared with the controls. Imported fire ant whole-body extract does not seem to degrade mountain cedar protein. Mixtures of allergenic extracts may be able to include IFA whole-body extract.

Cross-reactivity between allergens in the venom of the common striped scorpion and the imported fire ant

Background The common striped scorpion, Centruroides vittatus, and the imported fire ant (IFA) are endemic to the south-central United States. There is evidence of venom-specific IgE in patients experiencing hypersensitivity reactions to scorpion stings. The infrequency of repeated scorpion stings and the presence of immediate reactions to an initial sting suggest prior sensitization. Objective In the present study we evaluated the cross-reactivity of C vittatus venom with IFA whole-body extract (WBE). Methods Sera were obtained from patients with symptoms of immediate hypersensitivity to C vittatus stings and from scorpion sting–naive patients allergic to IFA venom. Inhibition IgE immunoblots were performed by using scorpion venom and IFA WBE. Skin testing with scorpion venom was performed on scorpion sting–naive patients allergic to IFA venom. Results Sera from patients with scorpion venom allergy demonstrated IgE binding to multiple allergens of similar sizes against both scorpion venom and IFA WBE. This binding was completely inhibited by preincubation of the sera with scorpion venom and IFA WBE. Pooled sera from patients with IFA venom allergy demonstrated similar bands on IgE immunoblotting against both IFA WBE and scorpion venom, with the latter being completely inhibited by preincubation of the sera with IFA WBE. Skin testing with scorpion venom was positive in 6 of 9 patients with IFA venom allergy. Conclusion Significant cross-reactivity exists between the venom of C vittatus and IFA WBE. The high sensitization rate to IFA venom in endemic areas may therefore be a risk factor for subsequent immediate reactions to an initial scorpion sting. Patients with immediate hypersensitivity reactions to scorpion stings may potentially benefit from immunotherapy with IFA WBE.

Safety and efficacy of an imported fire ant rush immunotherapy protocol with and without prophylactic treatment

Background: Hypersensitivity to the sting of the imported fire ant (IFA) is a growing and significant cause of morbidity and mortality in the United States. Conventional immunotherapy with IFA whole body extract (WBE) has been shown to be effective; however, rush immunotherapy (RIT) with IFA WBE has not been studied. Objective: In this study, we evaluated the safety and efficacy of RIT with IFA WBE and sought to determine whether prophylactic pretreatment with antihistamines and steroids reduces the systemic reaction rate associated with RIT. Methods: Patients with IFA hypersensitivity were randomized to placebo or twice-daily terfenadine 60 mg, ranitidine 150 mg, and prednisone 30 mg initiated 2 days before RIT in a double-blinded study. The 2-day RIT protocol consisted of hourly injections to achieve a final dose of 0.3 mL 1:100 wt/vol. Patients returned on day 8 to receive 2 hourly injections of 0.25 mL 1:100 wt/vol (total, 0.5 mL) and again on day 15 for a single injection of 0.5 mL 1:100 wt/vol. Efficacy of the protocol was determined on day 22, a pair of IFA sting challenges being performed 2 hours apart. Results: Fifty-nine patients were enrolled into the study; a total of 58 patients (age range, 18 to 49 years) initiated the 2-day RIT. Only 3 patients (5.2%) experienced a mild systemic reaction during the protocol. Among those experiencing a systemic reaction with RIT, there was no statistical difference between the 2 premedication groups (3.6% active and 6.7% placebo; P = .87). Sting challenges were performed on 56 patients for a total of 112+ stings; only 1 mild systemic reaction occurred (efficacy, 98.2%). Conclusion: RIT with IFA WBE for IFA hypersensitivity is both safe and efficacious; the rate of mild systemic reactions is low. Premedication is not necessary, inasmuch as prophylactic pretreatment with antihistamines and steroids did not reduce the systemic reaction rate associated with RIT. (J Allergy Clin Immunol 2002;109:556-62.)

The Editors' Choice

The Editors' Choice

Resolution of Debilitating Large Local Reaction from Imported Fire Ant Stings with Rush Immunotherapy: A Case Report

Although treatment of systemic reactions with both flying Hymenoptera and imported fire ant (IFA) with immunotherapy is the standard of care, immunotherapy is currently not recommended for the perceived relatively minor hazard of large local reactions. However, some large local reactions can be debilitating, resulting in severe swelling, pain and discomfort as well as loss of function of an extremity. The objective of this study was to evaluate whether rush immunotherapy (RIT) with IFA whole-body extract can prevent debilitating large local reactions to the sting of the IFA. An 8-year-old boy with debilitating large local reactions to the sting of IFAs underwent a 2-day RIT protocol with IFA whole-body extract. Sting challenges were performed before, 30, and 90 days after RIT. The area of the wheal and flare were measured at 1-hour post-sting and the area of induration at 24 hours. There was a 96% increase in the 1-hour post-sting wheal at 1 month but a 60% decrease from baseline at 3 months post-RIT. The 1-hour flare was increased by 63% at 1 month but reduced by 16% from baseline at 3 months post-RIT. Induration at 24 hours was reduced by 26% at 1-month post-RIT and by 94% by 3 months. The patient tolerated RIT and the sting challenges without complications. We conclude that RIT may be effective in significantly attenuating the magnitude of debilitating, large local reactions from the sting of the IFA. (Pediatr Asthma Allergy Immunol 2000;14[4]333–338.)

Reactivity to Imported Fire Ant Whole Body Extract in Allergic Patients with No History of Insect Sting Allergy

ABSTRACT Members of the Fire Ant Subcommittee of the American Academy of Allergy and Immunology (AAA&I) examined the skin test reactivity to imported fire ant whole body extract (IFA-WBE) among patients referred for evaluation of allergic conditions other than insect sting hypersensitivity. Intradermal skin testing with 1:1000 w/v concentration of Solenopsis invicta whole body extract demonstrated positive reactivity in 102 of 450 (22.7%) patients referred for evaluation of allergic disorders other than insect sting allergy. The prognostic significance of IFA-WBE skin test reactivity in individuals without a history of insect sting allergy is unknown.

Imported fire ant allergy in young children: Skin reactivity and serum IgE antibodies to venom and whole body extract

We studied 19 young children (aged 15 to 39 months) who had had a systemic allergic reaction after imported fire ant (IFA) sting. Skin testing was performed with whole body extract (WBE) of both Solenopsis species; positive reactions to S. invicta was noted in 94% and to S. richteri in 100%. Serum was tested for total IgE level and for specific IgE antibodies by RAST with WBE and venom (V) of S. invicta. In vitro results were compared with those of 19 age and sex-matched atopic control subjects. The range of total serum IgE level was 31 to 1720 IU/ml (geometric mean 160 IU/ml), compared with 7.5 to 6756 IU/ml (geometric mean 85 IU/ml) in the control subjects. The difference between the two groups, however, was not statistically significant ( p > 0.05). In the IFA-allergic group, the IFA WBE RAST mean binding was 13.5% (range 2.0% to 30.2%), and the IFA V RAST mean was 29.2% (range 7.8% to 46.7%). The control sera demonstrated low levels of activity to both IFA WBE RAST (0.7% to 4.8%) and IFA V RAST (0.7% to 5.9%). IFA WBE RAST demonstrated that 26% of the IFA-allergic patients had counts within the range of the atopic control subjects. In contrast, the IFA V RAST clearly separated all IFA-allergic patients from their age and sex-matched atopic control subjects. A scoring system for IFA V RAST is proposed. These results demonstrate superiority of IFA V over IFA WBE RAST in the diagnosis of allergy to S. invicta.

Crossed immunoelectrophoretic studies of whole body extracts and venom from the imported fire ant Solenopsis invicta

Although allergic reactions occur after imported fire ant (IFA) sting, currently, only IFA whole body extract (IFAWBE) is available for diagnosis and immunotherapy of IFA-sensitive individuals. We report our crossed immunoelectrophoretic studies comparing antigenicity and allergenicity of Solenopsis invicta IFAWBE and IFA venom (IFAV). Rabbits were hyperimmunized with IFAWBE prepared from S. invicta or with IFAV obtained from S. invicta by an electric shock method. Crossed immunoelectrophoresis with anti-IFAWBE detected at least 29 precipitin lines in IFAWBE and three lines in IFAV, but none in a synthetic venom, transpiperidine. Anti-IFAV detected six precipitin lines in IFAV and five lines in IFAWBE, but no lines were detected with transpiperidine. Crossed-line immunoelectrophoresis confirmed the IFAV origin of at least three of the peaks in IFAWBE. Crossed radioimmunoelectrophoresis with 11 IFAWBE RAST-positive sera elicited radiostaining with five antigens in IFAWBE that were probably IFAV associated. One of these allergens was recognized by all sera; the other allergens were recognized by 8, 7, 5, and 4, respectively, of the 11 sera. Four of the antigens present in IFAV preparations had allergenicity. These findings indicate that IFA allergens probably originate in IFAV, but that transpiperidine, a major constituent of IFAV, does not appear to be immunogenic. The results suggest that IFAV may be a more appropriate reagent than IFAWBE for laboratory testing and for clinical diagnosis and immunotherapy of IFA-sensitive individuals.

405 Partial purfication and allergenic characterization of imported fire ant (IFA) whole body extract (IFAWBE)

405 Partial purfication and allergenic characterization of imported fire ant (IFA) whole body extract (IFAWBE)

415 Specific IgE and IgG responses to immunotherapy (IT) with imported fire ant whole body extract (IFA-WBE) in IFA hypersensitivity (H)

415 Specific IgE and IgG responses to immunotherapy (IT) with imported fire ant whole body extract (IFA-WBE) in IFA hypersensitivity (H)