From the Department of Immunology, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
Division of Allergy and Immunology, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Allergy Asthma Proc. 2021 Jul 1;42(4):350-356. doi: 10.2500/aap.2021.42.210024.
Hymenoptera venom allergy is an immunoglobulin (Ig) E mediated hypersensitivity reaction to Hymenoptera venoms. Obvious identification of the culprit insect that causes the clinical symptoms and, hence, the accurate selection of venom for curative treatment, is of great importance for the effectiveness and safety of venom immunotherapy. In this study, the contribution of component-resolved diagnostics (CRD) is evaluated in the diagnosis of Hymenoptera venom allergy. Ninety-three patients from four different centers in Turkey were included in the study. Conventional tests, including prick and intradermal skin tests, with commercial venom extracts and serum specific IgE (sIgE) levels for whole venoms were performed. An sIgE analysis for venom allergen components, including rApi m 1, rApi m 2, rApi m 10, rVes v 1, rVes v 5, were evaluated by immunoblotting. In conventional test results, 17 of 35 patients with bee venom allergy were positive to honey bee venom, whereas 18 patients were positive to bee and wasp venoms. In 28 of 35 patients with bee venom allergy, the diagnosis was confirmed with CRD. CRD revealed a sensitivity of 80% in patients with bee venom allergy. According to conventional tests, 7 of 24 patients with vespid venom allergy demonstrated sensitivity only to species, whereas 17 patients revealed double positivity. The total diagnostic sensitivity of Ves v 1 and Ves v 5 was calculated as 87.5%. Ten of 23 patients with a history of hypersensitivity to both venoms showed double sensitivity with CRD; one patient had cross-reactivity, one patient was found to be sensitive only to bee venom, and, eight patients were sensitive only to species. Eleven patients had an uncertain history in terms of the culprit insect type and six of them had double sensitivity in CRD. CRD seemed to be more helpful in diagnosing vespid venom allergy than bee venom allergy. It can also discriminate clinically significant sensitizations from irrelevant ones.
蜂类毒液过敏是一种免疫球蛋白（Ig）E 介导的对蜂类毒液的过敏反应。明确引起临床症状的罪魁祸首昆虫，并因此准确选择毒液进行治疗，对于毒液免疫治疗的有效性和安全性非常重要。 在这项研究中，评估了组分分辨诊断（CRD）在诊断蜂类毒液过敏中的作用。 来自土耳其四个不同中心的 93 名患者纳入研究。进行了常规测试，包括皮刺和皮内皮肤测试，使用商业毒液提取物和血清特异性 IgE（sIgE）水平进行全毒液检测。通过免疫印迹法评估了毒液过敏原成分的 sIgE 分析，包括 rApi m 1、rApi m 2、rApi m 10、rVes v 1、rVes v 5。 在常规测试结果中，35 名蜜蜂毒液过敏患者中有 17 名对蜜蜂毒液呈阳性，而 18 名患者对蜜蜂和黄蜂毒液呈阳性。在 35 名蜜蜂毒液过敏患者中，28 名患者的诊断通过 CRD 得到确认。CRD 在蜜蜂毒液过敏患者中的敏感性为 80%。根据常规测试，24 名黄蜂毒液过敏患者中，7 名仅对 种敏感，而 17 名患者呈双重阳性。Ves v 1 和 Ves v 5 的总诊断敏感性计算为 87.5%。10 名有过两种毒液过敏史的患者在 CRD 中表现出双重敏感性；1 名患者表现出交叉反应，1 名患者仅对蜜蜂毒液敏感，8 名患者仅对 种敏感。23 名有过两种毒液过敏史的患者中，11 名患者的致敏昆虫类型不确定，其中 6 名患者在 CRD 中表现出双重敏感性。 CRD 似乎比蜜蜂毒液过敏更有助于诊断黄蜂毒液过敏。它还可以区分有临床意义的致敏与无关致敏。
