Department of Dermatology and Allergy, LMU University Hospital, LMU Munich, Munich, Germany, Frauenlobstr. 9-11, D-80337 Munich,Germany.
The Walter and Eliza Hall Institute of Medical Research and Department of Medical Biology, University of Melbourne, Melbourne 3052, VIC, Australia.
Br J Dermatol. 2024 Nov 18;191(6):1000-1007. doi: 10.1093/bjd/ljae290.
Hyaluronidase is an ubiquitous enzyme, present, among others, in hymenoptera venom and in medical formulations. The latter include use as an emergency treatment or to correct undesired outcomes of medical and aesthetic procedures using hyaluronic acid fillers.
By performing detailed allergy work-ups including skin-prick tests (SPTs) we investigated whether patients with a history of allergic reaction to hymenoptera venom are also sensitized to medical grade hyaluronidase.
Ninety patients with a history of type-1 reaction to hymenoptera venom with and without a history of previous specific venom immunotherapy were included in the study. All underwent SPTs for medical hyaluronidase. All patients also underwent serological analysis for Api m2, the only commercially available IgE test for a hymenoptera hyaluronidase.
Of the 90 patients with previous type-1 reactions to hymenoptera venom hyaluronidase included in the study, 60 had undergone previous venom immunotherapy; 30 did not. The majority (73 of 90) were allergic to wasps, followed by honeybees (14 of 90) and three were allergic to both. Neither patients having undergone previous immunotherapy nor those allergic to bees showed positive SPTs to medical hyaluronidase. Of those with a wasp allergy and naïve to immunotherapy, over 20% (5 of 23) showed positive SPTs to medical hyaluronidase. Healthy controls (0 of 30) without previous allergic reactions to hymenoptera did not show positive SPTs to medical hyaluronidase.
Sensitization to hyaluronidase is most common in wasp-allergic patients who have not had previous specific immunotherapy. As allergic reactions to medical hyaluronidase are reported to be scarce, this group is probably at the highest risk to develop anaphylaxis to medical hyaluronidase. While all patients with untreated anaphylaxis to hymenoptera venom should consult an allergy specialist, it is particularly important that those with untreated wasp allergies seek specialist advice before treatment with medical hyaluronidase is initiated.
透明质酸酶是一种普遍存在的酶，存在于膜翅目毒液和医学制剂中。后者包括将其作为紧急治疗或纠正使用透明质酸填充物的医学和美容程序的不良后果的用途。
通过进行详细的过敏检测工作，包括皮肤点刺试验（SPT），我们调查了对膜翅目毒液过敏反应的患者是否也对医用级透明质酸酶敏感。
纳入 90 例有 1 型膜翅目毒液过敏史的患者，其中包括有和无既往特异性毒液免疫治疗史的患者。所有患者均接受了医用透明质酸酶 SPT。所有患者还接受了 Api m2 的血清学分析，这是唯一一种可用于膜翅目透明质酸酶的商业 IgE 检测。
在纳入研究的 90 例有既往 1 型膜翅目毒液过敏史的患者中，60 例曾接受过毒液免疫治疗，30 例未接受过。大多数（90 例中的 73 例）对黄蜂过敏，其次是蜜蜂（90 例中的 14 例），还有 3 例对两者均过敏。既往接受过免疫治疗的患者或对蜜蜂过敏的患者，均未对医用透明质酸酶的 SPT 呈阳性。在对黄蜂过敏且未接受过免疫治疗的患者中，超过 20%（23 例中的 5 例）对医用透明质酸酶的 SPT 呈阳性。无既往对膜翅目过敏史的健康对照组（30 例中的 0 例）对医用透明质酸酶的 SPT 无阳性反应。
对透明质酸酶的致敏最常见于未接受过特异性免疫治疗的黄蜂过敏患者。由于报道的医用透明质酸酶过敏反应罕见，因此该组发生医用透明质酸酶过敏反应的风险最高。虽然所有未治疗的膜翅目毒液过敏反应患者均应咨询过敏专家，但对于未治疗的黄蜂过敏患者，在开始使用医用透明质酸酶治疗之前，特别需要咨询过敏专家的意见。
