Gentlesk M J, Hamilton R G, Adkinson N F, Mansmann H C
Int Arch Allergy Appl Immunol. 1983;71(3):233-40. doi: 10.1159/000233396.
The IgG antibody (Ab) response achieved with specific venom immunotherapy was explored in 32 patients with Hymenoptera hypersensitivity. Venom-specific IgG Ab was quantitated before and after 1 year of immunotherapy using two solid phase radioimmunoassay (SPRIA) methods. An agarose-based test using 125I-Staphylococcus aureus Protein A (SPRIA) was used to determine specific IgG for five Hymenoptera species: yellow jacket (YJ), honeybee (HB), yellow-faced hornet (YH), white-faced hornet (WFH), and Polistes (POL). A cellulose disk test using 125I-anti-IgG (IgG RAST) was available only for YJ and HB venoms. Acceptable agreement (90% concordance) was observed with IgG anti-HB levels measured in the two assays. For the YJ-IgG, however, 17/69 (25%) of sera positive in the SPRIA were negative in the IgG RAST, whereas the converse was not observed. This result suggests that the IgG RAST is insufficiently sensitive to detect YJ-IgG responses in all patients on maintenance level immunotherapy. Using the Protein A SPRIA, there was excellent agreement between the venom used for immunotherapy and the specificity of the IgG Ab response. In 31 patients treated with a total of 90 venom species, 90/90 venom IgG levels were increased or maintained at high pretreatment levels in response to immunotherapy. In the same patients venom IgG levels obtained for venom species not included in therapy were undetectable or declined in 55/60 cases; in 4 cases treatment with YJ venom stimulated a WFH and/or YH IgG response, the remaining case, YJ venom stimulated a small rise in POL IgG. These apparent discrepancies can be explained by variable cross-reactivity among vespid and POL venoms. Among 32 patients with a combined total of 87 positive venom skin tests, 1 year of specific immunotherapy resulted in greater than 5 micrograms/ml of venom-specific IgG in 61 instances. In 25 instances, the level of venom IgG was detectable but less than 5 micrograms/ml, and in 1 case venom IgG could not be detected. Based on recent analyses by Golden et al., some or all of these latter 26 cases may represent suboptimal therapy despite a standard immunotherapy regimen. We conclude that venom IgG measurements can provide a specific and quantitative assessment of the immunologic response to venom therapy, and that such assessment may be clinically useful in detecting instances of suboptimal immunotherapy.
在32例膜翅目昆虫过敏患者中探索了特异性毒液免疫疗法所产生的IgG抗体（Ab）反应。使用两种固相放射免疫分析（SPRIA）方法，在免疫疗法1年前后对毒液特异性IgG Ab进行定量。一种基于琼脂糖的检测方法，使用125I-金黄色葡萄球菌蛋白A（SPRIA）来测定针对5种膜翅目昆虫的特异性IgG：黄胡蜂（YJ）、蜜蜂（HB）、黄脸胡蜂（YH）、白脸胡蜂（WFH）和长脚胡蜂（POL）。一种使用125I-抗IgG的纤维素盘检测（IgG RAST）仅适用于YJ和HB毒液。两种检测方法所测的抗HB IgG水平具有可接受的一致性（90%相符）。然而，对于YJ-IgG，在SPRIA中呈阳性的69份血清中有17份（25%）在IgG RAST中呈阴性，而相反的情况未观察到。这一结果表明，IgG RAST在检测所有维持水平免疫疗法患者的YJ-IgG反应时灵敏度不足。使用蛋白A SPRIA，免疫疗法所用毒液与IgG Ab反应的特异性之间具有极好的一致性。在总共接受90种毒液治疗的31例患者中，90/90种毒液的IgG水平因免疫疗法而升高或维持在高于治疗前的水平。在同一组患者中，未包含在治疗中的毒液种类所测得的毒液IgG水平在55/60例中检测不到或下降；在4例中，用YJ毒液治疗激发了WFH和/或YH IgG反应，其余1例中，YJ毒液刺激POL IgG略有升高。这些明显的差异可以用胡蜂毒液和POL毒液之间可变的交叉反应性来解释。在32例共有87次阳性毒液皮肤试验的患者中，1年的特异性免疫疗法在61例中产生了大于5微克/毫升的毒液特异性IgG。在25例中，毒液IgG水平可检测到但低于5微克/毫升，在1例中未检测到毒液IgG。根据戈尔登等人最近的分析，尽管采用了标准的免疫疗法方案，但后26例中的部分或全部病例可能代表治疗效果欠佳。我们得出结论，毒液IgG测量可以对毒液治疗的免疫反应提供特异性和定量评估，并且这种评估在检测免疫疗法效果欠佳的情况时可能具有临床实用性。
