Ruëff F, Jappe U, Przybilla B
AllergieZentrum, Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, Frauenlobstr. 9-11, 80337, München.
Hautarzt. 2010 Nov;61(11):938-45. doi: 10.1007/s00105-010-1966-z.
In patients with a history of anaphylactic sting reactions, in-vitro tests are performed in order to demonstrate venom sensitization to the causative venom. Measurement of specific IgE-antibodies (sIgE) to the natural composite venom represents the standard in-vitro method to demonstrate venom sensitization. If sensitization to the composite venom cannot be demonstrated, one may determine sIgE to recombinant allergen compounds, in order to demonstrate sensitization to molecular venom allergens. Moreover, several cellular tests are available to confirm venom sensitization. Herein basophils, which carry cell-bound sIgE, can be used to produce a confirmatory response upon incubation with venom allergens. Reactions to both honey bee and vespid venom may either indicate true double sensitization or cross sensitization. The identification of antibodies cross-reacting to venoms and to other allergen sources does not exclude clinical relevance. Elevated baseline serum tryptase is a risk factor for severe systemic reactions after a field sting and during venom immunotherapy (VIT), the latter in particular for VIT with vespid venom. Serum tryptase measurement should, therefore, be included into routine diagnostics of venom allergy. The measurement of IgG-antibodies specific to venom is not recommended for routine work-up. None of the mentioned in-vitro tests, which may be used before, during or after VIT, allow, however, a precise prognosis with respect to future sting reactions, or to side effects and to the efficacy of VIT, respectively. To validate the reason for a VIT, one should also consider patient history and results of other tests.
对于有过敏性蜂蜇反应病史的患者，需进行体外试验以证明对致病毒液的致敏情况。检测针对天然复合毒液的特异性IgE抗体（sIgE）是证明毒液致敏的标准体外方法。如果无法证明对复合毒液的致敏，可检测针对重组变应原化合物的sIgE，以证明对分子毒液变应原的致敏。此外，还有几种细胞试验可用于确认毒液致敏。在此，携带细胞结合型sIgE的嗜碱性粒细胞可用于在与毒液变应原孵育时产生确认性反应。对蜜蜂和黄蜂毒液的反应可能表明真正的双重致敏或交叉致敏。识别与毒液和其他变应原来源交叉反应的抗体并不排除临床相关性。基线血清类胰蛋白酶升高是野外蜂蜇后和毒液免疫治疗（VIT）期间发生严重全身反应的危险因素，后者尤其适用于黄蜂毒液的VIT。因此，血清类胰蛋白酶检测应纳入毒液过敏的常规诊断。不建议在常规检查中检测针对毒液的IgG抗体。然而，上述任何一种体外试验，无论在VIT之前、期间还是之后使用，都无法分别对未来蜂蜇反应、副作用或VIT疗效做出准确预测。为验证VIT的必要性，还应考虑患者病史和其他检查结果。
