Maimonides Biomedical Research Institute of Cordoba (IMIBIC).
Department of Allergology, Reina Sofia University Hospital, Córdoba, Spain.
J Investig Allergol Clin Immunol. 2016;26(6):355-361. doi: 10.18176/jiaci.0053.
Different clinical behaviors have been identified in patients allergic to bee venom. Compound-resolved diagnosis could be an appropriate tool for investigating these differences. The aims of this study were to analyze whether specific IgE to Api m 4 (sIgE-Api m 4) can identify a particular kind of bee venom allergy and to describe response to bee venom immunotherapy (bVIT).
Prospective study of 31 patients allergic to bee venom who were assigned to phenotype group A (sIgE-Api m 4 <0.98 kU/L), treated with native aqueous (NA) extract, or phenotype group B (sIgE-Api m 4 ≥0.98 kU/L), treated with purified aqueous (PA) extract. Sex, age, cardiovascular risk, severity of preceding sting reaction, exposure to beekeeping, and immunological data (intradermal test, sIgE/sIgG4-Apis-nApi m 1, and sIgE-rApi m 2-Api m 4 were analyzed. Systemic reactions (SRs) during bVIT build-up were analyzed. Immunological and sting challenge outcomes were evaluated in each group after 1 and 2 years of bVIT.
Phenotype B patients had more severe reactions (P=.049) and higher skin sensitivity (P=.011), baseline sIgE-Apis (P=.0004), sIgE-nApi m 1 (P=.0004), and sIgG4-Apis (P=.027) than phenotype A patients. Furthermore, 41% of patients in group B experienced SRs during the build-up phase with NA; the sting challenge success rate in this group was 82%. There were no significant reductions in serial intradermal test results, but an intense reduction in sIgE-nApi m 1 (P=.013) and sIgE-Api m 4 (P=.004) was observed after the first year of bVIT.
Use of IgE-Api m 4 as the only discrimination criterion demonstrated differences in bee venom allergy. Further investigation with larger populations is necessary.
对蜂毒过敏的患者表现出不同的临床特征。复合分辨率诊断可能是研究这些差异的合适工具。本研究的目的是分析特异性 IgE 至 Api m 4(sIgE-Api m 4)是否可以识别特定类型的蜂毒过敏,并描述蜂毒免疫治疗(bVIT)的反应。
对 31 名对蜂毒过敏的患者进行前瞻性研究,根据血清 IgE-Api m 4 值将患者分为表型 A 组(sIgE-Api m 4<0.98 kU/L),接受天然水提物(NA)治疗,或表型 B 组(sIgE-Api m 4≥0.98 kU/L),接受纯化水提物(PA)治疗。分析性别、年龄、心血管风险、先前蜇伤反应的严重程度、接触养蜂、免疫数据(皮内试验、sIgE/sIgG4-Apis-nApi m 1、sIgE-rApi m 2-Api m 4)。分析 bVIT 诱导期的全身性反应(SRs)。在 bVIT 治疗 1 年和 2 年后,评估每组的免疫和蜇伤挑战结果。
表型 B 患者的反应更严重(P=.049),皮肤敏感性更高(P=.011),基线时 sIgE-Apis(P=.0004)、sIgE-nApi m 1(P=.0004)和 sIgG4-Apis(P=.027)水平也高于表型 A 患者。此外,41%的表型 B 患者在 NA 诱导期出现 SRs,该组的蜇伤挑战成功率为 82%。皮内试验结果无明显变化,但 bVIT 治疗 1 年后,sIgE-nApi m 1(P=.013)和 sIgE-Api m 4(P=.004)显著降低。
仅使用 IgE-Api m 4 作为唯一的鉴别标准,表明蜂毒过敏存在差异。需要进一步进行更大规模人群的研究。