The role of component-resolved diagnosis in Hymenoptera venom allergy in clinical practice

Background: Hymenoptera venom allergy is an immunoglobulin (Ig) E mediated hypersensitivity reaction to Hymenoptera venoms. Obvious identification of the culprit insect that causes the clinical symptoms and, hence, the accurate selection of venom for curative treatment, is of great importance for the effectiveness and safety of venom immunotherapy. Objective: In this study, the contribution of component-resolved diagnostics (CRD) is evaluated in the diagnosis of Hymenoptera venom allergy. Method: Ninety-three patients from four different centers in Turkey were included in the study. Conventional tests, including prick and intradermal skin tests, with commercial venom extracts and serum specific IgE (sIgE) levels for whole venoms were performed. An sIgE analysis for venom allergen components, including rApi m 1, rApi m 2, rApi m 10, rVes v 1, rVes v 5, were evaluated by immunoblotting. Results: In conventional test results, 17 of 35 patients with bee venom allergy were positive to honey bee venom, whereas 18 patients were positive to bee and wasp venoms. In 28 of 35 patients with bee venom allergy, the diagnosis was confirmed with CRD. CRD revealed a sensitivity of 80% in patients with bee venom allergy. According to conventional tests, 7 of 24 patients with vespid venom allergy demonstrated sensitivity only to Vespula species, whereas 17 patients revealed double positivity. The total diagnostic sensitivity of Ves v 1 and Ves v 5 was calculated as 87.5%. Ten of 23 patients with a history of hypersensitivity to both venoms showed double sensitivity with CRD; one patient had cross-reactivity, one patient was found to be sensitive only to bee venom, and, eight patients were sensitive only to Vespula species. Eleven patients had an uncertain history in terms of the culprit insect type and six of them had double sensitivity in CRD. Conclusion: CRD seemed to be more helpful in diagnosing vespid venom allergy than bee venom allergy. It can also discriminate clinically significant sensitizations from irrelevant ones.

Bee Venom Allergy in Chinese Beekeepers and Patients Under Live Bee Apitherapy

Background: Hymenoptera stings are one of the common causes of anaphylaxis. The prevalence of systemic allergic reactions seems to be higher in highly exposed populations such as beekeepers and individuals receiving live bee acupuncture (LBA). However, there are a very few of studies on venom allergy in these populations. We performed two observational studies to describe the characteristics and risk factors of venom allergy in beekeepers and the LBA population.Methods: A total of 99 beekeepers and 127 individuals receiving live bee acupuncture were interviewed. Skin prick tests were performed on subjects with suspected bee venom allergy.Results: The prevalence of bee venom allergy was 34.3% among beekeepers and 29.0% in the LBA population. Systemic reactions occurred in 11.3% of the LBA population, and 28.3% of beekeepers. For beekeepers with exposure to 2-4 stings per year and ≥5 stings per year, the risk for developing venom allergy increased to 6.745-fold (95% CI 2.139-21.266) and 42.297-fold (95% CI 7.060-253.399) respectively, compared to the ≤1 sting per year group. Conversely, in the LBA population, compared to frequency ≤2 LBA stings per week, the adjusted OR of venom allergy was 0.281 (95% CI 0.075-1.047) and 0.166 (95% CI 0.045-0.612) for frequency 3-6 LBA stings per week and ≥7 stings per week respectively. The knowledge of adrenaline and venom immunotherapy was limited in both beekeepers and traditional doctors.Conclusion: The frequency of stings with high risk for bee venom allergy was >4/year in beekeepers and <3/week in the LBA population. The education on anaphylaxis management should be strengthened.