Cichocka-Jarosz Ewa
Department of Pediatrics Jagiellonian University Medical College, Krakow, Poland.
Folia Med Cracov. 2012;52(3-4):43-60.
Reactions to Hymenoptera stings may appear as local or systemic responses. According to European data, the incidence of systemic reactions to Hymenoptera stings in the general population is 0.3-7.5%, with the value being 0.3-0.8% in children and 14-43% in beekeepers. The most common systemic allergic (anaphylactic) reactions are caused by honeybees (Apis mellifera), and certain species of wasps in the family Vespidae. Severe generalized immediate-type allergic (anaphylactic) reactions to insect stings are of the highest clinical importance. They affect skin, gastrointestinal tract, respiratory and cardiovascular system. The classification of severity of anaphylactic reaction following insect stings is based on the 4-grade Mueller scale. Crucial in patomechanism of anaphylaxis are specific IgE antibodies directed against the components of the venom, which mediate the activation of mast cells, the main effector cells of anaphylaxis. Therapeutic management in insect venom allergy should be considered in the context of prophylaxis, intervention in case symptoms develop, prevention in the form of venom specific immunotherapy (VIT). There are two steps of VIT 1. Initial dose venom immunotherapy (given according to four protocols which differ the time to reach the maintenance dose) 2. Maintenance dose VIT, usually equal 100 µg. Standard treatment time should span 3-5 years. The main mechanisms of immune tolerance that are initiated by VIT are associated with: 1. a decreased reactivity of effector cells, 2. expansion of T regulatory lymphocytes with IL-10 expression. Therapeutic effectiveness amounts to 90-100% in wasp venom allergy and approximately 80% in bee venom allergy.
对膜翅目昆虫叮咬的反应可能表现为局部或全身反应。根据欧洲数据，普通人群中对膜翅目昆虫叮咬的全身反应发生率为0.3 - 7.5%，儿童中的发生率为0.3 - 0.8%，养蜂人中的发生率为14 - 43%。最常见的全身过敏（过敏反应）是由蜜蜂（西方蜜蜂）和胡蜂科的某些黄蜂种类引起的。对昆虫叮咬的严重全身性速发型过敏（过敏反应）具有最高的临床重要性。它们会影响皮肤、胃肠道、呼吸系统和心血管系统。昆虫叮咬后过敏反应严重程度的分类基于4级穆勒量表。过敏反应发病机制的关键是针对毒液成分的特异性IgE抗体，这些抗体介导肥大细胞（过敏反应的主要效应细胞）的激活。昆虫毒液过敏的治疗管理应在预防、症状出现时的干预以及毒液特异性免疫疗法（VIT）形式的预防的背景下考虑。VIT有两个步骤：1. 初始剂量毒液免疫疗法（根据四种不同达到维持剂量时间的方案给药）2. 维持剂量VIT，通常等于100μg。标准治疗时间应持续3 - 5年。由VIT引发的免疫耐受的主要机制与：1. 效应细胞反应性降低，2. 具有IL - 10表达的T调节淋巴细胞扩增有关。黄蜂毒液过敏的治疗有效率为90 - 100%，蜜蜂毒液过敏的治疗有效率约为80%。
