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hymenoptera venom allergy

Kyle Mikals, Douglas Beakes, Taylor A Banks
Hymenoptera venom allergy accounts for approximately 17% of all cases of anaphylaxis. Insect stings are a common occurrence across the world, with significant impact on active duty personnel. Venom immunotherapy (VIT) provides an effective treatment for those with systemic reactions to insect stings and other similar indications. We present a case of severe reaction to hymenoptera venom requiring an epinephrine drip and provide an overview for primary care providers on who should be referred to allergy or an allergist, carry an epinephrine auto-injector, and be a candidate for VIT...
October 2016: Military Medicine
Joaquín Sastre, Marina Sastre-Ibañez
PURPOSE OF REVIEW: To describe recent insights into how molecular diagnosis can improve indication and selection of suitable allergens for specific immunotherapy and increase the safety of this therapy. RECENT FINDINGS: As specific allergen immunotherapy targets specific allergens, identification of the disease-eliciting allergen is a prerequisite for accurate prescription of treatment. In areas of complex sensitization to aeroallergens or in cases of hymenoptera venom allergy, the use of molecular diagnosis has demonstrated that it may lead to a change in indication and selection of allergens for immunotherapy in a large proportion of patients when compared with diagnosis based on skin prick testing and/or specific IgE determination with commercial extracts...
September 28, 2016: Current Opinion in Allergy and Clinical Immunology
Matteo Ferrando, Diego Bagnasco, Giovanni Passalacqua, Gilda Varricchi, Giorgio Walter Canonica
INTRODUCTION: Since its introduction in clinical practice one century ago for the treatment of respiratory allergic diseases, allergen-specific immunotherapy (AIT) has exhibited a relevant clinical efficacy that was subsequently confirmed in controlled trials. Thus, AIT has been accepted worldwide, as testified by guidelines and international documents. AIT is considered pivotal in the management of allergic rhinitis with or without conjunctivitis and with or without asthma. These conditions, in addition to hymenoptera venom allergy, currently are the accepted indications...
September 19, 2016: Expert Opinion on Biological Therapy
Theo Gülen, Janne Björkander
Bee and wasp stings can cause allergic reactions. Although the local reactions are more frequent, anaphylaxis due to insect stings can be potentially fatal. Rapid recognition of anaphylaxis is therefore critical and reactions should immediately be treated with i.m. adrenaline. Patients having experienced anaphylaxis should be referred to an allergist for diagnostic evaluation and possible venom-immunotherapy (VIT). The clinical history is essential in diagnosis of venom allergy as the test results are not always reliable...
2016: Läkartidningen
M Schiener, B Eberlein, C Moreno-Aguilar, G Pietsch, P Serrano, M McIntyre, L Schwarze, D Russkamp, T Biedermann, E Spillner, U Darsow, M Ollert, C B Schmidt-Weber, S Blank
BACKGROUND: Hymenoptera stings can cause severe anaphylaxis in untreated venom-allergic patients. A correct diagnosis regarding the relevant species for immunotherapy is often hampered by clinically irrelevant cross-reactivity. In vespid venom allergy, cross-reactivity between venoms of different species can be a diagnostic challenge. To address immunological IgE cross-reactivity on molecular level, seven recombinant antigens 5 of the most important Vespoidea groups were assessed by different diagnostic setups...
August 6, 2016: Allergy
D Gutiérrez Fernández, A Moreno-Ancillo, S Fernández Meléndez, C Domínguez-Noche, P Gálvez Ruiz, T Alfaya Arias
INTRODUCTION: Hymenoptera venom immunotherapy (VIT) is an effective treatment but not one devoid of risk as both local and systemic adverse reactions may occur especially in the initial stages of treatment. We compared the tolerance to three buildup protocols of VIT and analyzed risk factors associated with adverse reactions occurring in this phase. METHODS: We enrolled 165 patients divided into three groups based on the buildup protocol used (3, 4, 9 weeks). Severity of systemic reactions was evaluated according to World Allergy Organization model...
April 19, 2016: Journal of Investigational Allergology & Clinical Immunology
Lisa Arzt, Danijela Bokanovic, Ines Schwarz, Christoph Schrautzer, Cesare Massone, Michael Horn, Werner Aberer, Gunter Sturm
Stings in the head region are considered to be a risk factor for severe systemic reactions to Hymenoptera stings. We supposed that stings in skin areas, which are well supplied with blood, lead to more severe reactions and tested our hypothesis in 847 patients with confirmed Hymenoptera venom allergy. However, symptom severity was independent from sting site: only 16.3% of patients with severe reactions were stung on the head (p=0.017). But we confirmed age > 40 years (p<0.001) as well as elevated basal tryptase levels (p=0...
June 27, 2016: Allergy
Patricia Kane Matron, Victoria Timms, Roisin Fitzsimons
Hymenoptera venom allergy is an immunoglobulin E (IgE)-mediated hypersensitivity to the venom of insects from the Hymenoptera order and is a common cause of anaphylaxis. A diagnosis of venom allergy is made by taking an accurate medical, family and social history, alongside specific allergy testing. Systemic reactions to Hymenoptera venom occur in a small proportion of the population; these range from mild to life-threatening in severity. Treatment for local reactions involves the use of cold packs, antihistamines, analgesia and topical corticosteroids to help alleviate swelling, pain and pruritus...
May 25, 2016: Nursing Standard
Martina Vachová, Petr Panzner, Ivana Malkusová, Jana Hanzlíková, Tomáš Vlas
BACKGROUND: A diagnosis of Hymenoptera venom allergy is based on clinical history and the results of skin tests and/or laboratory methods. OBJECTIVE: To analyze the utility of available laboratory tests in diagnosing Hymenoptera venom allergy. METHODS: Ninety-five patients with Hymenoptera venom allergy with a history of bee (35) or wasp (60) anaphylactic sting reaction and positive skin test with bee or wasp venom were included in this analysis...
May 2016: Allergy and Asthma Proceedings:
P Minale, D Bignardi, C Troise, S Voltolini, P Dignetti
Allergic diseases are under-diagnosed and undertreated despite their wide prevalence, and particularly anaphylaxis is often under-estimated. Evidence-based anaphylaxis guidelines developed by principal allergy organizations agree on increased prevalence of anaphylaxis, especially in patients younger than 18 years (18-27,30): this trend highlights the need for actions on anaphylaxis management and prevention (3,4). Lack of prompt connection between emergency department and allergy unit after discharge, and of a dedicated ICD-9th identification code (18-26), can delay diagnosis and treatment of anaphylaxis (28,29)...
May 2016: European Annals of Allergy and Clinical Immunology
Mark J A Rietveld, Marco W J Schreurs, Roy Gerth van Wijk, Paul L A van Daele, Maud A W Hermans
BACKGROUND: Systemic mastocytosis (SM) patients are at a high risk for anaphylaxis, with Hymenoptera as the main culprit. A screening instrument to identify which patients are sensitized to Hymenoptera before they experience anaphylaxis would therefore be of great value. The basophil activation test (BAT) is proposed as a possible tool for diagnosing Hymenoptera venom-related allergy (HVA), especially in patients in whom conventional allergy tests yield contradictory results. METHODS: We included outpatients with SM, according to WHO criteria, from September 2011 to January 2012...
2016: International Archives of Allergy and Immunology
M Nittner-Marszalska, E Cichocka-Jarosz, T Małaczyńska, B Kraluk, M Rosiek-Biegus, M Kosinska, R Pawłowicz, G Lis
BACKGROUND: The ultrarush protocol is an attractive approach in the buildup phase of venom immunotherapy (VIT-UR). However, the degree of risk of VIT-UR in children remains unknown. The objective of this study was to compare the safety of VIT-UR in children and adults. METHODS: We performed a study based on prospectively gathered medical records of children and adults with hymenoptera venom allergy treated with VIT-UR in 3 allergy centers in Poland. RESULTS: The study population comprised 134 children (mean [SD] age, 12...
2016: Journal of Investigational Allergology & Clinical Immunology
Troy W Baker, Joseph P Forester, Monica L Johnson, Jeremy M Sikora, Adrienne Stolfi, Mark C Stahl
BACKGROUND: It has been reported that the general population is not skillful at identifying stinging insects with the exception of the honeybee. No information is available to evaluate allergy physicians' accuracy with stinging insect identification. OBJECTIVE: To measure the accuracy of allergists' ability to identify stinging insects and assess their common practices for evaluating individuals with suspected insect hypersensitivity. METHODS: A picture-based survey and a dried specimen insect box were constructed to determine allergists' and nonallergists' accuracy in identifying insects...
May 2016: Annals of Allergy, Asthma & Immunology
Joanna Lange, Ewa Cichocka-Jarosz, Honorata Marczak, Agnieszka Krauze, Izabela Tarczoń, Ewa Świebocka, Grzegorz Lis, Piotr Brzyski, Anna Nowak-Węgrzyn
BACKGROUND: Differences in treatment approach still exist for children after systemic sting reactions. In addition, there are still some doubts about when systemic reactors should be treated with venom immunotherapy (VIT). OBJECTIVE: To determine the rate of sting recurrence and natural history of Hymenoptera venom allergy (HVA) in children not treated with VIT. METHODS: A total of 219 children diagnosed as having HVA who were not treated with VIT were identified in 3 pediatric allergology centers...
March 2016: Annals of Allergy, Asthma & Immunology
Victoria Cardona, Ignacio J Ansotegui
PURPOSE OF REVIEW: Component-resolved diagnosis (CRD) is an advanced tool capable of aiding the clinician in fine tuning the diagnosis of the causal allergens of a reaction with the added value of providing information of severity risk, potential cross-reactivity, and subsequently, guiding management measures. This review will focus on the advantages of CRD of anaphylaxis in clinical practice. RECENT FINDINGS: Research is continuously providing insight to which molecules are associated with genuine sensitization and/or potential severity risk for hymenoptera venom (Api m1, Ves v 1, Ves v 5, and Pol d 5), food allergy (seed storage proteins and nonspecific lipid transfer proteins), cofactor-enhanced food allergy (ω-5-gliadine, nonspecific lipid transfer proteins), red meat delayed anaphylaxis (α-gal), latex allergy (Hev b 1, Hev b 3, Hev b 5, and Hev b 6), and Anisakis allergy (Ani s 1, Ani s 4, Ani s 7, and Ani s 13); other molecules are primary associated with nonclinically relevant sensitizations, cross-reactivity, or mild reactions (carbohydrate determinants and profilins)...
June 2016: Current Opinion in Allergy and Clinical Immunology
Eleonora Savi, Silvia Peveri, Elena Makri, Valerio Pravettoni, Cristoforo Incorvaia
BACKGROUND: Cross-reactivity among Hymenoptera venoms is an important issue when prescribing venom immunotherapy (VIT). Using all venoms eliciting a positive response results in treatment excess and unjustified cost increase. The first in vitro method that helped to identify the really causative venom was RAST-inhibition, but in latest years also molecular allergy (MA) diagnostics, that detects specific sIgE to single venom allergens, was introduced. We compared the two methods in patients with double sensitization to Vespula spp...
2016: Clinical and Molecular Allergy: CMA
Erminia Ridolo, Marcello Montagni, Cristoforo Incorvaia, Gianenrico Senna, Giovanni Passalacqua
OBJECTIVE: As confirmed by systematic reviews and meta-analyses, allergen immunotherapy is clinically effective in the treatment of allergic diseases. In particular, subcutaneous immunotherapy is a pivotal treatment in patients with severe reactions to Hymenoptera venom, whereas subcutaneous immunotherapy and sublingual immunotherapy are indicated in the treatment of allergic rhinitis and asthma by inhalant allergens. Other allergies related to animal dander (other than cat, which is the most studied), such as dog, molds, occupational allergens, and insects, have also been recognized...
March 2016: Annals of Allergy, Asthma & Immunology
J Michel, K Brockow, U Darsow, J Ring, C B Schmidt-Weber, T Grunwald, S Blank, M Ollert
BACKGROUND: Anaphylaxis caused by hymenoptera venom allergy is associated with elevation of baseline serum tryptase (sBT) and/or mastocytosis in about 5% of patients. Up to now, no information has become available on single venom allergen sIgE reactivity and the usefulness of component-resolved approaches to diagnose this high-risk patient group. To address the component-resolved sIgE sensitization pattern and diagnostic sensitivity in hymenoptera venom-allergic patients with elevated sBT levels and/or mastocytosis, a panel of yellow jacket and honeybee venom allergens was applied on a widely used IgE immunoassay platform...
May 2016: Allergy
José M Urra, Carmen M Cabrera, Teresa Alfaya, Francisco Feo-Brito
Venom immunotherapy is the only curative intervention for subjects with Hymenoptera venom allergy who suffering systemic reactions upon bee or wasp stings. Venom immunotherapy can restore normal immunity against venom allergens, as well as providing to allergic subjects a lifetime tolerance against venoms. Nevertheless, it is necessary using safety assays to monitoring the development of tolerance in the VIT protocols to avoid fatal anaphylactic reactions. The purpose of this study was to assess the modifications in several markers of tolerance induction in subjects with Hymenoptera venom allergy undergoing immunotherapy...
February 2016: Molecular Immunology
Patrizia Bonadonna, Massimiliano Bonifacio, Carla Lombardo, Roberta Zanotti
Mast cell activation syndrome (MCAS) can be diagnosed in patients with recurrent, severe symptoms from mast cell (MC)-derived mediators, which are transiently increased in serum and are attenuated by mediator-targeting drugs. When KIT-mutated, clonal MC are detected in these patients, a diagnosis of primary MCAS can be made. Severe systemic reactions to hymenoptera venom (HV) represent the most common form of anaphylaxis in patients with mastocytosis. Patients with primary MCAS and HV anaphylaxis are predominantly males and do not have skin lesions in the majority of cases, and anaphylaxis is characterized by hypotension and syncope in the absence of urticaria and angioedema...
January 2016: Current Allergy and Asthma Reports
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