Ewan P W, Deighton J, Wilson A B, Lachmann P J
Molecular Immunopathology Unit, MRC Centre, Cambridge, U.K.
Clin Exp Allergy. 1993 Aug;23(8):647-60. doi: 10.1111/j.1365-2222.1993.tb01791.x.
This paper investigates the relationship between venom IgG levels and protection from stings. Venom-specific IgG antibody levels have been measured by radioimmunoassay in untreated wasp-(n = 38) and bee-allergic (n = 16) patients presenting with systemic reactions to stings and in a sub-group of these (wasp = 15; bee = 9), before and after the initial course of venom immunotherapy (VIT). A history was taken of all reactions, the last systemic reaction being graded on a scale of 1-8 and of the number and timing of stings. In untreated patients venom IgG levels were much higher in bee-allergic patients (mean +/- s.e. = 68.2 +/- 7.1% positive pool) than in the wasp group (27.1 +/- 4.2%) (P < 0.05 Mann-Whitney U-test). There was a marked rise in venom IgG after the initial course of VIT in the wasp group (geometric mean and 95% confidence intervals = 40.5%, 28.8-54.3) but a much smaller rise in the bee group (15.3%, 6.6-24.1), with no overlap in the 95% confidence intervals. Bee patients, who were mainly beekeepers or their relatives, had been more heavily immunized with venom than wasp patients. They had received: (i) more stings (mean number of stings: bee, 26; wasp, 4; P < 0.001) and (ii) more stings per year. Wasp patients received their smaller number of stings over a much longer period, up to 40 yr. There was no correlation between the severity of the last systemic reaction and the venom IgG levels alone or venom IgG and IgE levels in combined analysis in either bee or wasp patients. This study shows that the pattern of IgG response differs in bee and wasp-allergic subjects, and that most bee-allergic subjects with systemic reactions have high levels of venom IgG. The degree of immunization with venom seems to be an important determinant of the venom IgG level. Our findings suggest that venom-specific IgG levels do not predict systemic reactions to stings and are not useful for monitoring VIT. If protection from stings is IgG-mediated, our observations suggest that the relevant immune response is more complex, possibly involving IgG sub-classes, IgG antibodies to individual venom antigens or antibody affinity, and not adequately reflected by measurement of the concentration of venom-specific IgG.
本文研究了毒液IgG水平与蜇伤防护之间的关系。通过放射免疫分析法，对38例未经治疗的黄蜂过敏患者（n = 38）和16例蜜蜂过敏患者（n = 16）进行了检测，这些患者均出现了对蜇伤的全身反应，并且对其中一部分患者（黄蜂组15例；蜜蜂组9例）在毒液免疫疗法（VIT）初始疗程前后进行了检测。记录了所有反应的病史，将最后一次全身反应按照1 - 8级进行分级，并记录蜇伤的次数和时间。在未经治疗的患者中，蜜蜂过敏患者的毒液IgG水平（平均±标准误 = 68.2±7.1%阳性库）远高于黄蜂组（27.1±4.2%）（曼-惠特尼U检验，P < 0.05）。黄蜂组在VIT初始疗程后毒液IgG有显著升高（几何平均数及95%置信区间 = 40.5%，28.8 - 54.3），而蜜蜂组升高幅度小得多（15.3%，6.6 - 24.1），95%置信区间无重叠。蜜蜂组患者主要是养蜂人或其亲属，他们接触毒液的免疫程度比黄蜂组患者更高。他们遭受过：（i）更多的蜇伤（平均蜇伤次数：蜜蜂组26次；黄蜂组4次；P < 0.001）以及（ii）每年更多的蜇伤。黄蜂组患者在更长的时间内（长达40年）遭受的蜇伤次数较少。在蜜蜂或黄蜂患者的单独分析或联合分析中，最后一次全身反应的严重程度与单独的毒液IgG水平或毒液IgG和IgE水平之间均无相关性。本研究表明，蜜蜂和黄蜂过敏受试者的IgG反应模式不同，并且大多数有全身反应的蜜蜂过敏受试者毒液IgG水平较高。毒液的免疫程度似乎是毒液IgG水平的一个重要决定因素。我们的研究结果表明，毒液特异性IgG水平不能预测对蜇伤的全身反应，也无助于监测VIT。如果蜇伤防护是由IgG介导的，我们的观察结果表明相关免疫反应更为复杂，可能涉及IgG亚类、针对单个毒液抗原的IgG抗体或抗体亲和力，而毒液特异性IgG浓度的测量并不能充分反映这些情况。
