Insect Sting Allergy Research Articles

Allergic reactions to insect stings and bites.

Insect stings are an important cause of anaphylaxis. Anaphylaxis can also occur from insect bites but is less common. Insect venoms contain several well-characterized allergens that can trigger anaphylactic reactions. Effective methods to diagnose insect sting allergy and assess risk of future sting reactions have been developed. Management strategies using insect avoidance measures, self-injectable epinephrine, and allergen immunotherapy are very effective in reducing insect-allergic patients' risk of reaction from future stings. Diagnostic and management strategies for patients allergic to insect bites are less developed.

Insect Sting Allergy with Negative Venom Skin Test Responses

Purpose of the Study. To increase awareness about the patient with a negative skin test response and insect sting allergy and to determine the frequency and significance of negative skin test responses in patients with a history of systemic reactions to insect stings. Study Population. Subjects were recruited for insect sting challenge study using advertisements. Subjects with a history consistent with a systemic immunoglobulin E (IgE)-mediated allergy to insects were evaluated. Methods. Venom skin testing, serologic IgE venom testing, and insect sting challenges were conducted. Intradermal skin testing to venom extracts (ALK-Abello Labs, Copenhagen, Denmark) was conducted in a range from 0.001 μg/mL to 1.0 μg/mL. Venom-specific serum IgE was detected using radioallergosorbent testing (RAST) (on-site assay using precommercial …

Diagnosis of Hymenoptera venom sensitivity.

The objective of this review is to highlight recent advances in the preparation, documentation and performance of reagents and methods used in the diagnosis of Hymenoptera-venom-induced immediate-type hypersensitivity. The following potent allergens have been reported: (1) a low-molecular-weight honey-bee allergen (Api m 6) has been described; (2) venom allergens in the North American species of bumble-bee (Bombus pennsylvanicus) have been more fully characterized, with the focus on phospholipase A2; (3) the vespid venom Ves v 5 allergen has been structurally mapped to identify immunoglobulin-E-binding epitopes; (4) the possible role of carbohydrate antigen epitopes as a cause of cross-reactivity among honey-bee and vespid venom proteins has been reported; and (5) the venom of Pachycondyla chinensis, an ant found commonly in the Far East, has been described. The most significant reports during this period have focused on the less-than-ideal performance of the intradermal venom skin-test reagents. The issue of the patient that is positive for venom allergy history but negative for an intradermal venom skin test is raised, and it is suggested that there is a need for caution and the use of serology as a supplementary diagnostic test. The important issue this year is the reminder that intradermal skin tests may be negative in venom-allergic patients, possibly because of changes in the potency of the extracts. The clinical history should drive the diagnosis of insect-sting allergy. When negative confirmatory venom skin-test or serology results are considered to be inconsistent with a positive history, they should be repeated.

Oral Desensitisation in Cow Milk Allergy: Immunological Findings

In the literature there are several reports dealing with the possibility of a desensitising treatment in food allergy, but there are very few studies about the immunological mechanisms of oral desensitisation. We studied the immunological modifications in four children who underwent oral desensitisation with cow milk. Four children with cow milk allergy underwent oral desensitisation according to a standardized protocol. Total IgE, eosinophilic cationic protein in serum, and specific IgE and IgG4 to α-lactalbumin, to β-lactoglobulin and to casein were determined at the beginning of the treatment and after 6, 12 and 18 months in the 4 children treated. All the 4 treated patients successfully completed the treatment. Specific IgE to casein showed a significant reduction (p<0.01), while specific IgG4 to α-lactalbumin (p<0.02), to β-lactoglobulin (p<0.01) and to casein (p<0.01) showed a significant increase. Total IgE, eosinophilic cationic protein, and specific IgE to α-lactalbumin and to β-lactoglobulin did not show any significant modification. Control patients did not show any immunological modification and still had a positive double-blind, placebo-controlled food challenge. These results make us think that oral desensitisation in food allergy happens with the same mechanisms of traditional desensitising treatments for respiratory and insect sting allergies.

Antibody binding to venom carbohydrates is a frequent cause for double positivity to honeybee and yellow jacket venom in patients with stinging-insect allergy

Background: Up to 50% of patients with stinging-insect allergy have double-positive RAST results to honeybee and yellow jacket (YJ) venom. True double sensitization and crossreactivity through venom hyaluronidases are considered main reasons for this multiple reactivity. Objective: We investigated the role of antibodies against cross-reactive carbohydrate determinants in venom double positivity. Methods: CAP inhibition experiments were performed with crude oilseed rape (OSR) and timothy grass pollen extracts and a neoglycoprotein construct displaying a MUXF glycan, as present in pineapple-stem bromelain (MUXF-BSA). CAP to OSR was used as a rough measure for carbohydrate-specific IgE in individual sera. Results: CAP results to OSR pollen were positive in 2 of 14 single-positive honeybee venom sera, 2 of 16 single-positive YJ venom sera, and 33 (80.5%) of 41 double-positive sera (P < .00001, χ2 test). CAP inhibition was performed in 16 selected patients with a CAP class of 3 or higher to both venoms. In 9 of 11 patients with a highly positive CAP result to OSR (CAP score to OSR > CAP score to second venom), pollen extracts, MUXF-BSA, or both were able to completely inhibit IgE binding to one of the venoms, whereas this was not the case in 5 patients with a negative or weakly positive CAP result to OSR (CAP score to OSR < CAP score to second venom). Conclusions: The data suggest that carbohydrate-specific IgE is a major cause for the double positivity to honeybee and YJ venom seen in patients with Hymenoptera allergy. Because these antibodies may have low clinical relevance, they may severely impede the correct diagnosis of Hymenoptera venom allergy. (J Allergy Clin Immunol 2001;108:1045-52.)

The role of immunoglobulin E in allergy and asthma.

It has been nearly a century since the first suggestion that a soluble factor in plasma or serum might be responsible for the symptoms of allergic disease and asthma, and more than 30 yr since immunoglobulin E (IgE) was identified as the key molecule in mediating what are now described as type 1 hypersensitivity reactions (allergic asthma, allergic rhinitis, food allergy, atopic dermatitis, some forms of drug allergy, and insect sting allergy). Since that time, many of the details of the inflammatory cascade underlying allergy and asthma have been elucidated, and IgE is now known to play a key upstream role. The goals of this report are to review the cellular and molecular events set in motion by IgE and to examine the evidence for its participation in both the immediate allergic response and the late-phase or chronic inflammatory response in the skin and lungs.

The ACVD task force on canine atopic dermatitis (XXIV): allergen-specific immunotherapy

Allergen-specific immunotherapy (ASIT) has been used for years to treat dogs with atopic dermatitis (AD) and humans with atopic diseases. The efficacy of ASIT has been well documented for humans with respiratory atopic diseases and stinging insect allergy, but its effectiveness seems more controversial for patients with AD. In spite of insufficient evidence derived from randomized controlled trials, multiple open studies and a large body of clinical observations suggest that ASIT is effective in controlling the clinical signs of dogs with AD. As a result of the scarcity of evidence from controlled trials, the true efficacy of ASIT, and the optimal protocols for allergen dose and frequency of injection are currently unknown. Allergen-specific immunotherapy nevertheless may be included in the treatment of canine AD because of its potential advantages and limited disadvantages compared to other forms of therapy. There is no evidence, however, for the preference of any specific treatment protocol. The predictive value of historical, clinical and immunologic features related to the efficacy of ASIT in dogs with AD are discussed in this paper. Adverse reactions, and the requirements for monitoring of patients receiving ASIT, then are reviewed and detailed. Finally, this review highlights aspects of ASIT where further research and controlled studies are needed.

Insect sting allergy with negative venom skin test responses

Background: In our 1976 controlled venom immuno rapy trial, 33% of 182 patients with a history of systemic reactions to insect stings were excluded because of negative venom skin test responses. There have been reports of patients with negative skin test responses who have had severe reactions to subsequent stings. Objective: Our aim is to increase awareness about the patient with a negative skin test response and insect sting allergy and to determine the frequency and significance of negative skin test responses in patients with a history of systemic reactions to insect stings. Methods: We prospectively examined the prevalence of negative venom skin test responses in patients with a history of systemic reactions to stings. In patients who gave informed consent, we analyzed the outcome of retesting and sting challenge. Results: Of 307 patients with positive histories screened for our sting challenge study, 208 (68%) had positive venom skin test responses (up to 1 μg/mL concentration), and 99 (32%) had negative venom skin test responses. In 36 (36%) of the 99 patients with negative skin test responses, the venom RAST result was a low positive (1-3 ng/mL), or repeat venom skin test responses were positive; another 7 (7%) patients had high venom-specific IgE antibody levels (4-243 ng/mL). Notably, 56 (57%) of 99 patients with positive histories and negative skin test responses had negative RAST results. In patients with positive skin test responses, sting challenges were performed in 141 of 196 patients, with 30 systemic reactions. Sting challenges were performed on 37 of 43 patients with negative skin test responses and positive venom-specific IgE and in 14 of 56 patients with negative skin test responses and negative RAST results. There were 11 patients with negative skin test responses who had systemic reactions to the challenge sting: 2 had negative RAST results, and 9 had positive RAST results at 1 ng/mL. The frequency of systemic reaction was 21% in patients with positive skin test responses and 22% in patients with negative skin test responses (24% in those with positive RAST results and 14% in those with negative RAST results). Conclusions: Venom skin test responses can be negative in patients who will subsequently experience another systemic sting reaction. Venom skin test responses are negative in many patients with a history of systemic allergic reactions to insect stings and may be associated with positive serologic test responses for venom-specific IgE antibodies (sometimes strongly positive results). Venom skin test responses should be repeated when negative, along with a serologic IgE antivenom test. Better diagnostic skin test reagents are urgently needed. (J Allergy Clin Immunol 2001;107:897-901.)

Insect sting allergy: The dilemma of the negative skin test reactor

Insect sting allergy: The dilemma of the negative skin test reactor

The safety and efficacy of immunotherapy with aluminum hydroxide-adsorbed venom extract of Vespula spp. An open, retrospective study

specific immunotherapy for Hymenoptera Venom (VIT) is considered a life-saving treatment in insect sting allergy. A few studies with depot VIT have been published, but they are mainly focussed on patients sensitized to Apis. this retrospective study was designed to evaluate both efficacy and safety of depot VIT for Vespula. Thirty-six patients (age range 6-73 years) with a history of systemic reactions (grade III to IV according to Mueller) after a Vespula sting, and specific sera IgE RAST to Vespula at least class 2, were administered a depot preparation of venom reaching 50 microgram as monthly maintenance dose. After the first year the maintenance dose was administered every other month. Thirty-three patients were treated for a minimum of 5 years. Reactions to any new field sting of the relevant insect were recorded during the treatment and for 6 to 24 months after its interruption. the treatment showed an excellent tolerance, with only a few local side effects. Thirteen patients (11 Grade IV according to Mueller before VIT) under treatment showed only local reactions after each field sting (18 field stings in total) by the relevant insect. Four patients (3 Grade IV according to Mueller before VIT) had a total of 6 field stings after the interruption of the 5-year treatment, with only local reactions. according to our results, and in agreement with previous published studies, VIT for Vespula spp. with depot extracts has an excellent tolerance and is clinically effective.

Insect sting allergy: a matter of life and death.

Insect sting allergy: a matter of life and death.

IMMUNOTHERAPY: Introduction and Overview

Immunotherapy for treatment of allergic disease can be highly effective, providing relief of symptoms and affecting the natural history of the disease. The benefit of this treatment was first suggested early in the twentieth century, and studies during the last 3 to 4 decades confirm the clinical benefit and possible immunologic mechanisms. It is possible that the progression of inhalant allergic disease (allergic rhinitis) can be prevented. The concepts for optimal immunotherapy and minimization of potential side effects are well-established. In view of these developmerits and the additional increasing costs of medication to treat allergic disease, it is time to recommend greater use of immunotherapy for treatment of allergic respiratory disease. The value of immunotherapy for insect sting allergy is well-substantiated and continued education regarding its efficacy is still necessary. Future directions are promising with the development of recombinant proteins, different adjuvants, and more effective delivery systems.

STINGING INSECT VACCINES: Patient Selection and Administration of Hymenoptera Venom Immunotherapy

Elucidation of the natural history of insect sting allergy is critical to the development of guidelines and practice parameters for the evaluation and prevention of insect sting anaphylaxis. There remains a need for long-term observations and correlations that may yet provide the indicator of clinical and immunologic factors that accurately predict the individual patient’s risk of anaphylaxis to future stings. One goal to consider is the identification of subjects at risk for insect sting anaphylaxis even before the first event.

Venom immunotherapy: when to start, when to stop.

Over the past 25 years, major advances have been made in the diagnosis and treatment of insect sting allergy. Controlled clinical trials have demonstrated the efficacy of venom immunotherapy (VIT) in the prevention of subsequent systemic reactions in allergic individuals. We have refined our criteria for selection of patients for VIT. Studies on selections of venoms, rush immunotherapy, and interval between VIT injections have been performed. Finally, much work has been done to try to define criteria for the discontinuation of VIT.

Stinging insect allergy

Stinging insect allergy

Debilitating beliefs, emotional distress and quality of life in patients given immunotherapy for insect sting allergy.

Patients who receive immunotherapy for systemic reaction to insect stings are told that once they reach maintenance dose they are almost 100% protected against future systemic reactions. However, we have observed that some patients continued to perceive themselves as highly debilitated by the allergy, and this perception had a significant impact on their quality of life. To validate this clinical observation and to explore possible reasons for such an undesired psychological reaction. The study group consisted of 97 patients who regularly attended an allergy outpatient clinic for venom immunotherapy, and who had been under medical surveillance for up to 8 years. They completed a questionnaire measuring debilitating beliefs, preoccupation with the systemic reaction event, emotional distress, perceived restriction by allergy, and perceived quality of life. We also recorded the duration of immunotherapy, physician-graded severity of the systemic reaction and the frequency at which immunotherapy was administered. The reference group consisted of patients who had not reached maintenance dose and were still at risk of recurrent systemic reactions. As many as one-third of the patients held self-imposed debilitating beliefs, were preoccupied with the systemic reaction event, perceived a moderate to severe impairment in their quality of life, and manifested symptoms of emotional distress. These psychological responses did not correlate with the immunotherapy dosage that had been reached. Patients who reached a full maintenance dose were doing no better psychologically than those in the reference group. Moreover, the length of time on immunotherapy did not result in attenuation of the psychological responses. This study demonstrates for the first time, the long-lasting psychological impact of a threatening systemic reaction. It suggests a need for intervention aimed at dispelling patients' unfounded and persisting debilitating beliefs.

Epidemiological study of the prevalence of allergic reactions to Hymenoptera in a rural population in the Mediterranean area.

Systemic allergic reactions to Hymenoptera venom occur in a percentage that varies from 0.4 to 3.3%. Epidemiological studies indicate that from 15 to 25% of the general population can be sensitized to different Hymenoptera venom as well as the fact that the degree of exposure may be related to the prevalence found in those studies. The objective of this study was to evaluate the prevalence of insect sting allergy and the venom sensitization in a rural population to three Hymenoptera previously found in the area: Polistes dominulus (Pd), Vespula germanica (Vg) and honey bee (Hb). A rural community located in the south-east of Spain, close to the Mediterranean Sea, was selected since the stinging Hymenoptera having been previously identified. A random sample of 310 subjects from the village census was studied. A questionnaire and a serum sample were obtained from every patient. The evaluation was conducted by a family doctor, who focused on the reactions to Hymenoptera sting, age, sex, occupation, atopia, previous Hymenoptera sting, stinging insect, interval to last sting and average stings per year. RAST to Hymenoptera venoms were also determined. The prevalence of systemic reactions was 2.3% (57.6% of them had a positive RAST). Large local reactions were found in 26.4% (only 28.5% of them had a positive RAST). Asymptomatic sensitization (positive RAST) was observed in 16.4% of subjects without reaction. Only a weak correlation between subjects with less than 3 years' interval to last sting exposure and positive RAST results was noted, whether they presented with a clinical reaction or not (P < 0.05). The prevalence of systemic sting reactions in our rural community is higher than other general populations in the same Mediterranean area, and similar to other rural populations studied. The degree of exposure influences not only the prevalence found but also the detection of specific serum IgE.

STINGING INSECT HYPERSENSITIVITY: A PRACTICE PARAMETER

STINGING INSECT HYPERSENSITIVITY: A PRACTICE PARAMETER

A Common Profile of Immunodominant Epitopes Is Associated with Symptomatic Allergy

This paper describes work on the detection of IgG to different allergens of food origin, aeroallergens, and venom allergens related to insect sting allergy, and presents data acquired in various studies on their clinical relevance. Our studies on the fine specificity of the reactions show that allergic subjects do not recognize the same set of immunodominant epitopes on the major allergens as do healthy subjects, or as they themselves do at the time of naturally acquired or induced clinical tolerance. Allergic patients have preferential expression of immunoglobulin (Ig) G antibodies directed to conformational epitopes, whereas natural antibodies from healthy or asymptomatic patients are basically specific for structural epitopes. Nevertheless, using antibody competition assays, we have demonstrated that the immunodominance profile differs in the two clinically defined situations for both types of epitopes. The gain in specificity for allergy tests using this new approach, based on discriminant epitope recognition to detect the allergens that are associated with symptoms, instead of those that are merely associated with sensitization, means that it is a promising new approach in the field of allergy diagnosis.

Stinging insect allergy

Stinging insect allergy is a relatively common medical problem, responsible for an estimated 40 fatalities per year in the USA and considerable anxiety and lifestyle modification. There are no criteria to identify people at risk of initial venom anaphylaxis. Reactions may occur at any age and are unrelated to the time interval of prior venom exposure. There is an approximate 60% re-sting reaction rate in people who have had sting anaphylaxis and have positive venom skin tests. Re-sting reactions are more likely to occur in adults than in children and in people who have had more severe anaphylactic symptoms. Positive venom intradermal skin tests confirm the diagnosis of potential stinging insect allergy in people who have had sting reactions. Venom immunotherapy provides almost 100% protection from further sting reactions. It is recommended for all people who have had venom anaphylaxis and have positive skin tests, except for children who have dermal reactions only. Details of venom dosing are well established. The adequate duration of venom immunotherapy is still an unresolved issue. Conversion to a negative skin test appears to be an absolute criterion to discontinue treatment. In the presence of a persistent positive skin test, 3–5 years of immunotherapy is generally sufficient. People who have had severe reactions, such as loss of consciousenss, may require indefinite therapy.