Stevens W J, Ebo D G, De Clerck L S, Bridts C H, De Gendt C M, Mertens A V
Department of Immunology, University of Antwerp, Antwerpen, Belgium.
Clin Exp Allergy. 1998 Feb;28(2):249-52. doi: 10.1046/j.1365-2222.1998.00222.x.
Venom immunotherapy (VIT) has proven to be safe and effective in wasp venom anaphylaxis. However, there are no good parameters to indicate when to stop venom immunotherapy.
To evaluate the relationship of the lymphocyte transformation test (LTT) to history and specific IgE determination, and to address the time course of lymphocyte transformation responses to wasp (Vespula) venom during VIT and the possible utility of LTT to determine the duration of therapy.
Peripheral blood mononuclear cells (PBMCs) of 18 individuals with a history of wasp sting anaphylaxis and a positive serum-venom-specific IgE, were stimulated with wasp venom before immunotherapy, at the end of a 5-day semi-rush immunotherapy and at 24 months during venom immunotherapy. Results, expressed as stimulation index (SI), were compared with the SI in seven asymptomatic stung controls.
In controls the median (minimum-maximum) of the SI were 2.39 (0.52-3.39) before therapy and 2.39 (1.12-6.02) when repeated after 24 months. For patients the median (minimum-maximum) of the SI were 10.13 (1.19-44.88) before immunotherapy (d0), 2.73 (0.67-12.03) at the end of the build-up immunotherapy (d5) and 4.21 (0.88-14.66) at the end of 24 months of maintenance therapy (m24). The proliferation responses in vespid-allergic patients were significantly higher than in stung controls (P = 0.006) but only 13/18 patients showed a positive LTT result before the start of immunotherapy (sensitivity of the LTT 72%). When the LTT was repeated after a 5 day build-up hyposensitization course the SI significantly dropped as compared to the pre-treatment levels (P = 0.002). The SI of the LTT was negative in eight out of 18 patients at 24 months and the median values were significantly lower than before therapy (P = 0.03).
Although, in the absence of sting challenge data it is not possible to draw conclusions about the predictive value of the LTT, our data may suggest that abolition of the LTT during VIT might indicate clinical insensitivity. Further studies, comparing the results of sting challenges, with the results of lymphocyte transformation will be necessary in order to evaluate the role of LTT in stopping immunotherapy.
毒液免疫疗法（VIT）已被证明在黄蜂毒液过敏反应中是安全有效的。然而，目前尚无良好的指标来指示何时停止毒液免疫疗法。
评估淋巴细胞转化试验（LTT）与病史及特异性IgE测定之间的关系，并探讨在VIT期间对黄蜂（胡蜂属）毒液的淋巴细胞转化反应的时间进程以及LTT在确定治疗持续时间方面的可能效用。
对18例有黄蜂蜇伤过敏史且血清毒液特异性IgE呈阳性的个体，在免疫治疗前、5天半快速免疫治疗结束时以及毒液免疫治疗24个月时，用黄蜂毒液刺激外周血单个核细胞（PBMC）。结果以刺激指数（SI）表示，并与7例无症状蜇伤对照者的SI进行比较。
在对照组中，治疗前SI的中位数（最小值 - 最大值）为2.39（0.52 - 3.39），24个月后重复检测时为2.39（1.12 - 6.02）。对于患者，免疫治疗前（d0）SI的中位数（最小值 - 最大值）为10.13（1.19 - 44.88），累积免疫治疗结束时（d5）为2.73（0.67 - 12.03），维持治疗24个月结束时（m24）为4.21（0.88 - 14.66）。黄蜂过敏患者的增殖反应显著高于蜇伤对照者（P = 0.006），但仅13/18例患者在免疫治疗开始前LTT结果呈阳性（LTT敏感性为72%）。在进行5天的递增减敏疗程后重复LTT时，与治疗前水平相比，SI显著下降（P = 0.002）。18例患者中有8例在24个月时LTT的SI为阴性，且中位数显著低于治疗前（P = 0.03）。
尽管在缺乏蜇刺激发试验数据的情况下，无法就LTT的预测价值得出结论，但我们的数据可能表明，在VIT期间LTT转阴可能提示临床不敏感。为了评估LTT在停止免疫治疗中的作用，有必要进一步开展研究，比较蜇刺激发试验结果与淋巴细胞转化结果。
