Bee/Vespula Venom-Specific IgE Ratio Greater Than 5:1 Indicates Culprit Insect in Double-Sensitized Patients.

IF 8.2 1区医学 Q1 ALLERGY Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-01-01 Epub Date: 2024-11-04 DOI:10.1016/j.jaip.2024.10.029

Simon Tischler, Axel Trautmann, Matthias Goebeler, Johanna Stoevesandt

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Abstract

Background: Venom-allergic patients are frequently double-sensitized to honeybee venom (BV) and Vespula venom (VV). Genuine double allergy is uncommon.

Objectives: To assess whether a quantitative comparison of BV- and VV-specific IgE levels permits an identification of the culprit venom in double-sensitized patients, and to evaluate whether independent sensitization to BV- and VV-specific components corresponds to an indication for double immunotherapy.

Methods: This single-center observational study evaluated 1,069 consecutive patients; 490 nonallergic controls were available for statistical comparison. The diagnosis (BV allergy, VV allergy, or double allergy) was based on a comprehensive allergological workup including patient history, IgE serology, intradermal skin test, and, when required, basophil activation testing. Quantitative allergen-specific IgE to BV, VV, rApi m 1, and rVes v 5 was retrospectively compared with the final diagnosis. The ratio of BV/VV-specific IgE levels was considered in double-sensitized venom-allergic patients.

Results: Sensitization to whole-venom preparations and components was frequent in patients and asymptomatic controls, with higher specific IgE levels in the patient group. At least 5:1 dominance of the specific IgE to either BV or VV was documented in 239 of 459 double-sensitized venom-allergic patients (52.1%). Of these patients 232 (97.1%) received a diagnosis of monoallergy to only the venom to which they were dominantly sensitized.

Conclusions: Dominant specific IgE at a ratio of 5:1 indicates the culprit venom in double-sensitized allergic patients. Additional component-resolved diagnostic testing can be restricted to cases with double sensitization to whole venom at a ratio of less than 5:1. Double sensitization to rApi m 1 and rVes v 5 per se does not justify double venom immunotherapy.

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蜜蜂/蛛毒特异性 IgE 比率≥5:1 表示双重过敏患者的罪魁祸首是昆虫。

背景：毒液过敏患者经常对蜜蜂毒液（BV）和蝰蛇毒液（VV）双重过敏；真正的双重过敏并不常见：评估 BV 和 VV 特异性 IgE 水平的定量比较是否允许确定双重过敏患者的罪魁祸首毒液；评估对 BV 和 VV 特异性成分的独立过敏是否与双重免疫疗法的适应症相对应：这项单中心观察性研究对 1069 名连续患者进行了评估；490 名非过敏对照者可用于统计比较。诊断（BV 过敏、VV 过敏、双重过敏）基于全面的过敏学检查，包括患者病史、IgE 血清学检查、皮内皮肤测试，必要时还包括嗜碱性粒细胞活化测试。对 BV、VV、rApi m 1、rVes v 5 的过敏原特异性 IgE 定量与最终诊断进行回顾性比较；对双重过敏的毒液过敏患者考虑 BV/VV 特异性 IgE 水平的比值：结果：在患者和无症状对照组中，经常出现对整个毒液制剂和成分过敏的情况，患者组的特异性 IgE 水平更高。在 459 名双重毒液过敏患者中，有 239 人（52.1%）对 BV 或 VV 的特异性 IgE 至少以 5:1 的比例占优势；其中 232 人（97.1%）被诊断为只对其主要过敏的毒液单一过敏：结论：5:1 主导特异性 IgE 显示了双重过敏患者的罪魁祸首毒液。额外的成分分辨诊断测试可仅限于对整个毒液双重过敏且比例小于 5:1 的病例。对 rApi m 1 和 rVes v 5 双重过敏本身并不能证明双重毒液免疫疗法是正确的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.