Sección de Alergia, Hospital Universitario Reina Sofía, Córdoba, Spain.
J Investig Allergol Clin Immunol. 2011;21(1):28-33.
In Mediterranean regions, double sensitization to Polistes and Vespula species is frequent in patients reacting to an unidentified wasp sting. Since both genera are present, it is often difficult to determine which insect is responsible and, consequently, select venom for immunotherapy. When a specific diagnosis cannot be made, a new therapeutic strategy should be undertaken.
We performed a case-control study in which 37 patients who were allergic to venom from Vespula and Polistes species received a 3-year schedule of alternating immunotherapy. Twenty monosensitized patients (10 to Vespula and 10 to Polistes) received conventional venom immunotherapy (VIT) during the same period. All 57 patients received the same number of injections. The effectiveness of VIT was assessed by means of re-sting, which was performed yearly. Serum specific immunoglobulin (Ig) E and IgG4 were also studied,
All the cases tolerated all the stings. One control patient developed a mild systemic reaction after the first-year Vespula sting but tolerated subsequent re-stings. Both cases and controls reached significant changes in levels of IgE and IgG4 after VIT (P < .04 at minimum). The cases developed a response as expected, although this was less intense than in the control group. In the Polistes control subgroup, sIgE to Polistes decreased to under baseline levels, after a marked initial increase; this decrease was not observed in the Vespula subgroup.
An alternating VIT strategy is appropriate and provides protection to patients sensitized to Vespula and Polistes.
在地中海地区，对不明胡蜂蜇伤产生过敏反应的患者常对胡蜂属和马蜂属的物种呈双重过敏。由于这两个属都存在，通常很难确定是哪种昆虫引起过敏，因此也难以选择用于免疫治疗的毒液。当无法做出明确诊断时，应采取新的治疗策略。
我们进行了一项病例对照研究，纳入了 37 例对胡蜂属和马蜂属毒液过敏的患者，他们接受了为期 3 年的交替免疫治疗方案。同期，20 例单重过敏患者（10 例对胡蜂过敏，10 例对马蜂过敏）接受了常规蜂毒免疫疗法（VIT）。所有 57 例患者接受了相同数量的注射。通过每年进行的再蜇刺评估 VIT 的有效性。还研究了血清特异性免疫球蛋白（Ig）E 和 IgG4。
所有病例均耐受了所有蜇刺。1 例对照患者在第 1 年胡蜂蜇刺后出现轻度全身性反应，但耐受了随后的再蜇刺。在 VIT 后，病例和对照组的 IgE 和 IgG4 水平均发生了显著变化（至少 P <.04）。尽管与对照组相比，这种反应较弱，但病例确实产生了预期的反应。在马蜂对照组亚组中，Polistes 特异性 IgE 降低至基线水平以下，而在胡蜂对照组亚组中则未观察到这种降低。
交替 VIT 策略是合适的，可为对胡蜂和马蜂敏感的患者提供保护。
