REVIEW PAPER
Diagnosis of hymenoptera venom allergy – with special emphasis on honeybee (Apis mellifera) venom allergy
 
More details
Hide details
1
Department of Inorganic and Analytical Chemistry, Poznan University of Medical Sciences, Poland
2
Medical Faculty, Higher Vocational State School, Kalisz, Poland
3
Department of Paediatric Pneumonology, Allergology and Clinical Immunology, K. Jonscher Clinical Hospital, Poznan University of Medical Sciences, Poland
 
Ann Agric Environ Med. 2013;20(4):875–879
KEYWORDS
ABSTRACT
Hymenoptera stings occur very frequently and usually are not dangerous. The normal reaction after sting includes such symptoms as: mild swelling, redness and pain lasting from several minutes to several hours. In contrast, in people with allergy to insect venom, severe local reactions and systemic symptoms, including anaphylactic shock, may occur. Diagnostic tests should be performed in persons who experience systemic symptoms after a sting. The basic tests used in the diagnosis of allergy to hymenoptera venom are skin tests and detection of venom-specific IgE antibodies. If it is not possible to make a diagnosis on the basis of these data, specialized diagnostic tests, such as cellular tests, inhibition test and determination of tryptase and carboxypeptidase, can be performed. The presented study provides an overview of currently used diagnostic methods, both those used in everyday practice and allergy tests, which are available only in selected specialized centres.
 
REFERENCES (51)
1.
Grigoreas C, Galatas ID, Kiamouris C, Papaioannou D. Insect-venom allergy in Greek adults. Allergy 1997; 52(1): 51–57.
 
2.
Fernandez J, Blanca M, Soriano V, Sanchez J, Juarez C. Epidemiological study of the prevalence of allergic reactions to hymenoptera in a rural population in the Mediterranean area. Clin Exp Allergy. 1999; 29(8): 1069–1074.
 
3.
Incorvaia C, Mauro M, Pastorello EA. Hymenoptera stings in conscripts. Allergy 1997; 52(6): 680–681. Novembre E, Cianferoni A, Bernardini R, Veltroni M, Ingargiola A, Lombardi E, et al. Epidemiology of insect venom sensitivity in children and its correlation to clinical and atopic features. Clin Exp Allergy. 1998; 28(7): 834–838.
 
4.
Charpin D, Birnbaum J, Lanteaume A, Vervloet D. Prevalence of allergy to hymenoptera stings in different samples of the general population. J Allergy Clin Immunol. 1992; 90(3 Pt 1): 331–334.
 
5.
Schafer T, Przybilla B. IgE antibodies to hymenoptera venoms in the serum are common in the general population and are related to indications of atopy. Allergy 1996; 51(6): 372–377.
 
6.
Golden DB. Insect sting anaphylaxis. Immunol Allergy Clin North Am. 2007; 27(2): 261–272.
 
7.
Niedoszytko M, Majkowicz M, Chełmińska M, Buss T, GruchałaNiedoszytko M, Jassem E. Quality of life, anxiety, depression and satisfaction with life in patients treated with insect venom immunotherapy. Post Dermatol Alergol. 2012; 29(2): 74–79.
 
8.
Brzyski P, Cichocka-Jarosz E, Tobiasz-Adamczyk B, Lange J, Świebocka E, Lis G, Jedynak-Wąsowicz U, Pietrzyk JJ, Kulus M, Kaczmarski M, Małaczyńska T, Klajna-Kraluk B, Bręborowicz A, Kycler Z. Theoretical validity and reliability of Vespide Quality of Life Questionnaire in Polish adolescents with Hymenoptera venom allergy. Post Dermatol Alergol 2012; 29(1): 8–13.
 
9.
Moffitt JE, Golden DB, Reisman RE, Lee R, Nicklas R, Freeman T, et al. Stinging insect hypersensitivity: a practice parameter update. J Allergy Clin Immunol. 2004; 114(4): 869–886.
 
10.
Severino M, Bonadonna P, Passalacqua G. Large local reactions from stinging insects: from epidemiology to management. Curr Opin Allergy Clin Immunol. 2009; 9(4): 334–337.
 
11.
Brown SG. Clinical features and severity grading of anaphylaxis. J Allergy Clin Immunol. 2004; 114(2): 371–376.
 
12.
Przybilla B, Rueff F. Hymenoptera venom allergy. J Dtsch Dermatol Ges. 2010; 8(2): 114–127; quiz 128–130.
 
13.
Golden DB, Breisch NL, Hamilton RG, Guralnick MW, Greene A, Craig TJ, et al. Clinical and entomological factors influence the outcome of sting challenge studies. J Allergy Clin Immunol. 2006; 117(3): 670–675.
 
14.
Reisman RE. Unusual reactions to insect stings. Curr Opin Allergy Clin Immunol. 2005; 5(4): 355–358. Golden BK. Allergic reactions to hymenoptera. ACP Medicine. Immunology/Allergy. 2007; 15: 1–6.
 
15.
Golden DB, Marsh DG, Freidhoff LR, Kwiterovich KA, Addison B, Kagey-Sobotka A, et al. Natural history of hymenoptera venom sensitivity in adults. J Allergy Clin Immunol. 1997; 100(6 Pt 1): 760–766.
 
16.
Golden DB, Kagey-Sobotka A, Norman PS, Hamilton RG, Lichtenstein LM. Insect sting allergy with negative venom skin test responses. J Allergy Clin Immunol. 2001; 107(5): 897–901.
 
17.
Goldberg A, Confino-Cohen R. Timing of venom skin tests and IgE determinations after insect sting anaphylaxis. J Allergy Clin Immunol. 1997; 100(2): 182–184.
 
18.
Reisman RE. Insect sting allergy: the dilemma of the negative skin test reactor. J Allergy Clin Immunol. 2001; 107(5): 781–782.
 
19.
Golden DB, Tracy JM, Freeman TM, Hoffman DR. Negative venom skin test results in patients with histories of systemic reaction to a sting. J Allergy Clin Immunol. 2003; 112(3): 495–498.
 
20.
Blum S, Gunzinger A, Muller UR, Helbling A. Influence of total and specific IgE, serum tryptase, and age on severity of allergic reactions to hymenoptera stings. Allergy 2010; 66(2): 222–228.
 
21.
Bilo BM, Rueff F, Mosbech H, Bonifazi F, Oude-Elberink JN. Diagnosis of hymenoptera venom allergy. Allergy 2005; 60(11): 1339–1349.
 
22.
Rueff F, Jappe U, Przybilla B. Standards and pitfalls of in-vitro diagnostics of hymenoptera venom allergy. Hautarzt 2010; 61(11): 938–945.
 
23.
Rieger-Ziegler V, Rieger E, Kranke B, Aberer W. Hymenoptera venom allergy: time course of specific IgE concentrations during the first weeks after a sting. Int Arch Allergy Immunol. 1999; 120(2): 166–168.
 
24.
Dotimas EM, Hider RC. Honeybee venom. Bee World 1987; 62(2): 51–70.
 
25.
Kemeny DM, Harries MG, Youlten LJ, Mackenzie-Mills M, Lessof MH. Antibodies to purified bee venom proteins and peptides. I. Development of a highly specific RAST for bee venom antigens and its application to bee sting allergy. J Allergy Clin Immunol. 1983; 71(5): 505–514.
 
26.
Phadia, Uppsala, Sweden. http://www.phadia.com (access: 2013.04.03).
 
27.
Muller UR. New developments in the diagnosis and treatment of hymenoptera venom allergy. Int Arch Allergy Immunol. 2001; 124(4): 447–453.
 
28.
Niedoszytko M, de Monchy J, van Doormaal JJ, Jassem E, Oude Elberink JN. Mastocytosis and insect venom allergy: diagnosis, safety and efficacy of venom immunotherapy. Allergy. 2009; 64(9): 1237–1245.
 
29.
Sainte-Laudy J, Sabbah A, Drouet M, Lauret MG, Loiry M. Diagnosis of venom allergy by flow cytometry. Correlation with clinical history, skin tests, specific IgE, histamine and leukotriene C4 release. Clin Exp Allergy. 2000; 30(8): 1166–1171.
 
30.
Scherer K, Bircher AJ, Heijnen IA. Diagnosis of stinging insect allergy: utility of cellular in-vitro tests. Curr Opin Allergy Clin Immunol. 2009; 9(4): 343–350.
 
31.
Hamilton RG. Diagnostic methods for insect sting allergy. Curr Opin Allergy Clin Immunol. 2004; 4(4): 297–306.
 
32.
Simons FE. Anaphylaxis. J Allergy Clin Immunol. 2009; 125(2 Suppl 2): S161–181.
 
33.
Sturm GJ, Jin C, Kranzelbinder B, Hemmer W, Sturm EM, Griesbacher A, et al. Inconsistent results of diagnostic tools hamper the differentiation between bee and vespid venom allergy. PLoS One. 2011; 6(6): e20842.
 
34.
Hemmer W. Cross-reactivity to honeybee and wasp venom. Hautarzt 2008; 59(3): 194–199.
 
35.
Simons FE, Frew AJ, Ansotegui IJ, Bochner BS, Golden DB, Finkelman FD, et al. Risk assessment in anaphylaxis: current and future approaches. J Allergy Clin Immunol. 2007; 120(1 Suppl): S2–24.
 
36.
Manso EC, Morato-Castro FF, Yee CJ, Croce M, Palma MS, Croce J. Honeybee venom specific IgG subclass antibodies in Brazilian beekeepers and in patients allergic to bee stings. J Investig Allergol Clin Immunol. 1998; 8(1): 46–51.
 
37.
Eich-Wanger C, Muller UR. Bee sting allergy in beekeepers. Clin Exp Allergy. 1998; 28(10): 1292–1298.
 
38.
Muller UR. Bee venom allergy in beekeepers and their family members. Curr Opin Allergy Clin Immunol. 2005; 5(4): 343–347.
 
39.
Muller UR, Johansen N, Petersen AB, Fromberg-Nielsen J, Haeberli G. Hymenoptera venom allergy: analysis of double positivity to honey bee and Vespula venom by estimation of IgE antibodies to species-specific major allergens Api m1 and Ves v5. Allergy 2009; 64(4): 543–548.
 
40.
Haeberli G, Bronnimann M, Hunziker T, Muller U. Elevated basal serum tryptase and hymenoptera venom allergy: relation to severity of sting reactions and to safety and efficacy of venom immunotherapy. Clin Exp Allergy. 2003; 33(9): 1216–1220.
 
41.
Schwartz LB. Diagnostic value of tryptase in anaphylaxis and mastocytosis. Immunol Allergy Clin North Am. 2006; 26(3): 451–463.
 
42.
Schwartz LB, Bradford TR, Rouse C, Irani AM, Rasp G, Van der Zwan JK, et al. Development of a new, more sensitive immunoassay for human tryptase: use in systemic anaphylaxis. J Clin Immunol. 1994; 14(3): 190–204.
 
43.
Muller UR. Elevated baseline serum tryptase, mastocytosis and anaphylaxis. Clin Exp Allergy. 2009; 39(5): 620–622.
 
44.
Jogie-Brahim S, Min HK, Fukuoka Y, Xia HZ, Schwartz LB. Expression of alpha-tryptase and beta-tryptase by human basophils. J Allergy Clin Immunol. 2004; 113(6): 1086–1092.
 
45.
van der Linden PW, Struyvenberg A, Kraaijenhagen RJ, Hack CE, van der Zwan JK. Anaphylactic shock after insect-sting challenge in 138 persons with a previous insect-sting reaction. Ann Intern Med. 1993; 118(3): 161–168.
 
46.
Valent P, Sperr WR, Schwartz LB, Horny HP. Diagnosis and classification of mast cell proliferative disorders: delineation from immunologic diseases and non-mast cell hematopoietic neoplasms. J Allergy Clin Immunol. 2004; 114(1): 3–11; quiz 12.
 
47.
Sperr WR, Jordan JH, Baghestanian M, Kiener HP, Samorapoompichit P, Semper H, et al. Expression of mast cell tryptase by myeloblasts in a group of patients with acute myeloid leukemia. Blood 2001; 98(7): 2200–2209.
 
48.
Sperr WR, Stehberger B, Wimazal F, Baghestanian M, Schwartz LB, Kundi M, et al. Serum tryptase measurements in patients with myelodysplastic syndromes. Leuk Lymphoma. 2002; 43(5): 1097–1105.
 
49.
Guenova E, Volz T, Eichner M, Hoetzenecker W, Caroli U, Griesinger G, et al. Basal serum tryptase as risk assessment for severe hymenoptera sting reactions in elderly. Allergy 2010; 65(7): 919–923.
 
50.
Stone KD, Prussin C, Metcalfe DD. IgE, mast cells, basophils, and eosinophils. J Allergy Clin Immunol. 2010; 125(2 Suppl 2): S73–80.
 
51.
Lee JK, Vadas P. Anaphylaxis: mechanisms and management. Clin Exp Allergy. 2011; 41(7): 923–938.
 
eISSN:1898-2263
ISSN:1232-1966