Goldberg A, Confino-Cohen R, Mekori Y A
Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar Saba, Israel.
Ann Allergy Asthma Immunol. 1995 Jul;75(1):30-2.
Open environment and working conditions close to abundant insects of the order Hymenoptera should be avoided as much as possible by patients allergic to Hymenoptera venom who do not receive venom immunotherapy. After having experienced accidental field re-stings not resulting in a systemic reaction, some of these patients may be willing to resume normal life and working habits. Since venom-specific IgE usually remains elevated in these patients, repeated skin tests or RASTs are not helpful in identifying disappearance of their venom allergy.
The purpose of this study was to evaluate the usefulness of deliberate live sting challenge as a diagnostic tool in highly selected venom-allergic patients who had initially refused venom immunotherapy.
Two cases are reported of bee venom-allergic patients who had previously refused venom immunotherapy and subsequently experienced honeybee field re-stings not resulting in systemic reactions. Two to three years later, their skin tests remained positive for bee venom. A third patient allergic to Vespa orientalis who had negative skin tests to all available venoms was denied venom immunotherapy due to lack of proper commercial venom. Because none of the patients was receiving venom immunotherapy the military service personnel concluded they still had venom allergy and rejected them from the highly prestigious service. All three patients were anxious to confirm the disappearance of their venom allergy and we used deliberate live sting challenges for that purpose.
Two to three years after their initial systemic reactions live sting challenges were well tolerated by the three patients. They felt free to resume their normal life habits and were allowed to begin military service without further limitations.
Deliberate insect stings using appropriate safety precautions should be considered a diagnostic tool in selected allergic patients who do not receive venom immunotherapy but in whom a reliable history of negative field re-stings can be obtained despite positive skin tests and in those who continue to have inconclusive venom skin tests.
对于未接受蜂毒免疫疗法的蜂毒过敏患者，应尽可能避免开放环境以及靠近大量膜翅目昆虫的工作条件。在经历意外野外再次蜇伤但未引发全身反应后，部分此类患者可能愿意恢复正常生活和工作习惯。由于这些患者的蜂毒特异性IgE通常仍处于升高状态，重复进行皮肤试验或放射性变应原吸附试验对于确定其蜂毒过敏是否消失并无帮助。
本研究旨在评估在经过严格筛选、最初拒绝蜂毒免疫疗法的蜂毒过敏患者中，有意进行活蜂蜇刺激发试验作为诊断工具的有效性。
报告了2例曾拒绝蜂毒免疫疗法、随后经历野外蜜蜂再次蜇伤但未出现全身反应的蜂毒过敏患者。两到三年后，他们的蜂毒皮肤试验仍呈阳性。第3例患者对东方胡蜂过敏，对所有可用蜂毒的皮肤试验均为阴性，但因缺乏合适的商用蜂毒而未接受蜂毒免疫疗法。由于这些患者均未接受蜂毒免疫疗法，兵役人员认定他们仍有蜂毒过敏，拒绝他们进入享有盛誉的部队服役。所有3例患者都急于确认其蜂毒过敏是否已消失，为此我们进行了有意的活蜂蜇刺激发试验。
在最初的全身反应发生两到三年后，3例患者对活蜂蜇刺激发试验耐受良好。他们感到可以自由恢复正常生活习惯，并被允许开始服兵役，不再有进一步限制。
对于未接受蜂毒免疫疗法、尽管皮肤试验呈阳性但有可靠的野外再次蜇伤阴性病史的特定过敏患者，以及蜂毒皮肤试验结果仍不明确的患者，在采取适当安全措施的情况下，有意进行昆虫蜇刺应被视为一种诊断工具。
