A multicenter study on skin-test reactivity of human volunteers to venom as compared with whole body Hymenoptera antigens (original) (raw)
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Negative venom skin test results in patients with histories of systemic reaction to a sting
Journal of Allergy and Clinical Immunology, 2003
For more than 20 years venom immunotherapy has been the preferred treatment for Hymenoptera allergy and venom skin testing the preferred diagnostic test. Most allergists consider venom skin tests to be highly accurate and interpret a negative venom skin test result to indicate the absence of insect allergy. Furthermore, current practice guidelines do not adequately address the question of how best to manage the patient with a convincing history of insect allergy but negative skin test results. Recent case reports and published studies have forced us to reexamine this important management issue and to consider what role in vitro venom testing might have in the management of insect allergy. We reviewed the current status of what is known about the management of individuals with a history of insect allergy but negative venom skin test results and suggested modifications of current working guidelines.
International Archives of Allergy and Immunology, 2017
Background: Skin test reactivity to hymenoptera venom and venom-specific IgE are important for diagnosing venom allergy and deciding on the appropriate allergen for venom immunotherapy (VIT). Longitudinal data on skin test reactivity during VIT and their correlation with venom-specific immunoglobulin (Ig)E and IgG are scarce. Methods: We retrospectively analyzed shifts in skin test reactivity and serum levels of venom-specific IgE and IgG in patients allergic to hymenoptera venom before the initiation of VIT with ultrarush therapy and after ≥3 years of VIT. Results: Fifty-four patients received ultrarush desensitization and subsequent VIT with wasp venom, 26 with honeybee venom, and 8 with both wasp and honeybee venom. Hymenoptera-specific skin test reactivity decreased during VIT in most patients, and became negative in 8% of the wasp-allergic patients and in 25% of the honeybee-allergic patients. Serum levels of venom-specific IgE positively correlated to skin test reactivity befo...
Hymenoptera venom allergy: Taking the sting out of difficult cases
Journal of investigational allergology & clinical immunology: official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología
Background: Correct identifi cation of the culprit venom is a prerequisite for specifi c venom immunotherapy. Objective: To assess whether the basophil activation test (BAT) constitutes an additional diagnostic instrument in patients with equivocal or negative specifi c immunoglobulin (Ig) E or venom skin test (VST) results. Methods: One hundred eighteen patients with a compelling history of IgE-mediated hymenoptera venom allergy were enrolled. Venomspecifi c IgE was quantifi ed by ImmunoCAP and VST was performed in all patients. Basophil activation was analyzed by fl ow cytometry after labeling with anti-IgE and anti-CD63. Results: In 64 out of 118 patients, diagnosis was considered as defi nite and the entomologic description was confi rmed by unequivocal and concordant positive specifi c IgE and VST results. In 53 of those 64 patients, BAT confi rmed diagnosis, whereas the remaining 11 patients were nonresponsive in the BAT analysis. Forty-seven patients (40%) had a tentative diagnosis of venom allergy, as they had divergent specifi c IgE or VST results. In 31 of those patients, BAT was positive only for the suspected venom and helped to establish diagnosis of wasp and honeybee venom allergy in 28 and 3 patients, respectively. BAT was diagnostic in 7 patients with complete negative results for specifi c IgE and VST, despite clear entomologic identifi cation. Conclusions: In about half the patients with diagnosis of venom allergy, unequivocal specifi c IgE and VST results are obtained and additional tests are not needed. In the remainder, diagnosis is less straightforward due to discrepant or negative specifi c IgE or VST results. In these patients, BAT constitutes a helpful additional instrument to identify the culprit venom and start venom immunotherapy accordingly.
Expert Review of Clinical Immunology, 2014
For most people Hymenoptera stings result in transient and bothersome local inflammatory responses characterized by pain, itching, redness and swelling. In contrast, for those presenting an IgE-mediated allergic reaction, a re-sting may cause life-threatening reactions. In such patients, correct diagnosis is an absolute prerequisite for effective management, i.e. venom-specific immunotherapy. Generally, identification of the offending insect involves a detailed history along with quantification of venom-specific IgE antibodies and venom skin tests. Unfortunately, due to uncertainties associated with both tests, correct diagnosis is not always straightforward. This review summarizes the potentials and limitations of the various in vitro tests that are currently being used in the diagnosis of Hymenoptera venom allergy. Particular attention is paid to the potential of novel cellular tests such as basophil activation tests and component-resolved diagnosis with recombinant venom allergens in the diagnostic approach of patients with difficult diagnosis, i.e. cases in whom traditional venom specific IgE and skin tests yield equivocal or negative results. Finally, this review also covers the recent discoveries in the field of proteome research of Hymenoptera venoms and the selection of cell types for recombinant allergens production.
The Open Allergy Journal, 2010
Objective: To provide a comprehensive evaluation in patients with a convincing history of immediate insect allergy but negative skin test and/or specific IgE results, adequately addressing the question of how best to manage them. Data sources: Observational peer-reviewed studies and case reports were searched on Pub-Med database from 1998 up to March 2009 using the following keywords: Hymenoptera Allergy & Negative IgE (Negative Skin Tests). Study selection: Studies on supplemental diagnostic tests that provided data from patients with immediate hymenoptera allergy but negative conventional tests results to the offending allergens were selected. In this work, we also included studies providing additional relevant information regarding this issue. Results: Among 43 identified papers only 9 of them presented relevant original data, while the other papers were reviews. In the majority of the cases, the culprit insect was identified with in vitro tests such as Basophil Activation Test, ...
Basophil activation test in the diagnostics of hymenoptera venom allergy
Bratislava Medical Journal, 2021
The aim of the study was to analyse the diagnostic performance of the basophil activation test (BAT), to compare the diagnostic reliability of BATs performed with different types of allergens, which are available in Slovakia and to verify the correlation between the symptom severity and the sensitivity and specifi city of the BAT in 114 patients with suspected hymenoptera venom allergy (HVA). BACKGROUND: Diagnosis of the HVA and the identifi cation of the appropriate venom for immunotherapy are in Slovakia based on detailed patient'medical history, skin tests and detection of sIgE. In unclear cases, where the clinical decision regarding the relevant insect species for immunotherapy is diffi cult, the cellular tests are recommended in several countries, such as Sweden, Spain, Germany, Denmark and Italy. In Slovakia, BAT is not adapted as s part of routine diagnostic work-up. METHODS: The identifi cation of the culprit hymenoptera species among 114 patients was based on detailed history, skin tests and detection of sIgE. Obtained results were compared with the results acquired by the BAT. RESULTS: The sensitivity of the BAT was 80.8 % and the specifi city was 87.8 %. The sensitivity of the BAT was higher when using Soluprick SQ Allergens, but the specifi city was higher with BŰHLMANN CAST Allergens. In the study no correlation between the symptom severity and the sensitivity and specifi city of the BAT was observed. CONCLUSIONS: The results show that the BAT can be recommended in the identifi cation of the appropriate venom for immunotherapy, the only specifi c treatment that is currently available for patients with HVA. Allergen source is one of critical factors in diagnostic reliability of the BAT (Tab. 4, Ref.
Evaluation of a Novel Rapid Test System for the Detection of Specific IgE to Hymenoptera Venoms
Background. The Allergy Lateral Flow Assay (ALFA) is a novel rapid assay for the detection of sIgE to allergens. The objective of this study is the evaluation of ALFA for the detection of sIgE to bee venom (BV) and wasp venom (WV) in insect venom allergic patients. Methods. Specific IgE to BV and WV was analyzed by ALFA, ALLERG-O-LIQ, and ImmunoCAP in 80 insect venom allergic patients and 60 control sera. Sensitivity and specificity of ALFA and correlation of ALFA and ImmunoCAP results were calculated. Results. The sensitivity/specificity of ALFA to the diagnosis was 100%/83% for BV and 82%/97% for WV. For insect venom allergic patients, the Spearman correlation coefficient for ALFA versus ImmunoCAP was 0.79 for BV and 0.80 for WV. However, significant differences in the negative control groups were observed. Conclusion. ALFA represents a simple, robust, and reliable tool for the rapid detection of sIgE to insect venoms.
Approaches to the Management of Presumed Immediate Hymenoptera Venom Allergy and Non-Detectable IgE
The Open Allergy Journal, 2010
Objective: To provide a comprehensive evaluation in patients with a convincing history of immediate insect allergy but negative skin test and/or specific IgE results, adequately addressing the question of how best to manage them. Data sources: Observational peer-reviewed studies and case reports were searched on Pub-Med database from 1998 up to March 2009 using the following keywords: Hymenoptera Allergy & Negative IgE (Negative Skin Tests). Study selection: Studies on supplemental diagnostic tests that provided data from patients with immediate hymenoptera allergy but negative conventional tests results to the offending allergens were selected. In this work, we also included studies providing additional relevant information regarding this issue. Results: Among 43 identified papers only 9 of them presented relevant original data, while the other papers were reviews. In the majority of the cases, the culprit insect was identified with in vitro tests such as Basophil Activation Test, ...