Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, Munich, Germany.
Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Ancona, Italy.
Clin Exp Allergy. 2018 Apr;48(4):354-364. doi: 10.1111/cea.13090. Epub 2018 Feb 14.
Stings of Hymenoptera can induce IgE-mediated systemic and even fatal allergic reactions. Venom-specific immunotherapy (VIT) is the only disease-modifying and curative treatment of venom allergy. However, choosing the correct venom for VIT represents a necessary prerequisite for efficient protection against further anaphylactic sting reactions after VIT. In the past, therapeutic decisions based on the measurement of specific IgE (sIgE) levels to whole venom extracts were not always straightforward, especially when the patient was not able to identify the culprit insect. In the last years, the increasing knowledge about the molecular structure and relevance of important venom allergens and their availability as recombinant allergens, devoid of cross-reactive carbohydrate determinants, resulted in the development of an advanced component-resolved diagnostics (CRD) approach in venom allergy. Already to date, CRD has increased the sensitivity of sIgE detection and enabled the discrimination between primary sensitization and cross-reactivity, particularly in patients with sensitization to both honeybee and vespid venom. Hence, CRD in many patients improves the selection of the appropriate immunotherapeutic intervention. Moreover, the detailed knowledge about sensitization profiles on a molecular level might open new options to identify patients who are at increased risk of side-effects or not to respond to immunotherapy. Therefore, increasing potential of CRD becomes evident, to direct therapeutic decisions in a personalized and patient-tailored manner. Reviewed here are the state of the art options, recent developments and future perspectives of CRD of Hymenoptera venom allergy.
膜翅目昆虫蜇刺可引起 IgE 介导的全身性甚至致命的过敏反应。毒液特异性免疫治疗（VIT）是唯一可改变疾病进程和治愈的毒液过敏治疗方法。然而，选择正确的毒液进行 VIT 是在 VIT 后有效预防进一步过敏蜇刺反应的必要前提。过去，基于对全毒液提取物的特异性 IgE（sIgE）水平的测量来做出治疗决策并不总是那么简单，特别是当患者无法识别罪魁祸首昆虫时。近年来，对重要毒液过敏原的分子结构和相关性及其作为无交叉反应性碳水化合物决定簇的重组过敏原的可用性的认识不断提高，导致毒液过敏的先进组分分辨诊断（CRD）方法的发展。迄今为止，CRD 提高了 sIgE 检测的灵敏度，并能够区分原发性致敏和交叉反应性，特别是在对蜜蜂和胡蜂毒液均致敏的患者中。因此，CRD 可改善许多患者对适当免疫治疗干预的选择。此外，在分子水平上详细了解致敏谱可能为识别有发生副作用风险或对免疫治疗无反应的患者提供新的选择。因此，CRD 的潜力不断增加，可以更个性化和针对患者的方式来指导治疗决策。本文综述了膜翅目毒液过敏的 CRD 的最新进展、未来展望和最新进展。
