Bee venom hypersensitivity and its management: patients perception of venom desensitisation.

The objectives of the study were to review bee venom immunotherapy from the patient's perspective: in particular its benefits and its problems, and to investigate any genetic tendency for bee venom hypersensitivity. A self administered, 9 item questionnaire was sent to 219 patients who had undergone either inpatient or outpatient bee venom immunotherapy at Flinders Medical Center. The clinic records of these patients were also reviewed. The controls for the genetic study were sought from patients, staff and students at Flinders University and Flinders Medical Centre. One hundred and forty-six questionnaires (some incomplete and anonymous) were received. The female to male ratio was 1:2.5. The age at the time of the initial anaphylactic reaction to a bee sting ranged between 2 to 59 years, with 67% of patients being less then 20 years old. Forty percent of patients underwent venom immunotherapy for a period less than 2 years with only 11% maintaining therapy for the recommended period of 5 years or more. Thirty three percent of patients stopped their therapy on their own accord. Bee stings occurring during bee venom immunotherapy (n = 56) were generally well tolerated except in 8 subjects, 7 of whom had not reached the maintenance dose. The reduction in systemic reactions to subsequent bee stings was significantly better in the study group receiving bee venom than in an historic control group treated with whole bee extract (p = 0.03). Fear of bee stings and restricted life styles were improved during or after venom immunotherapy. The frequency of a positive family history of systemic reactions to bee stings in the patient cohort was 31%, whereas in controls it was 15% (p = 0.013). Bee venom immunotherapy has dual benefits: patients are protected from subsequent sting anaphylaxis and there is reduced psychological morbidity. However, to be effective, venom immunotherapy requires a prolonged period of carefully supervised treatment and each venom injection can cause local and systemic side effects. Genetic factors appear to be present in those patients who develop immediate hypersensitivity to be stings.

Standartization of an enzyme linked immunonosorbent assay (ELISA) for detecting circulating toxic venom antigens in patients stung by the scorpion Tityus serrulatus

Neste trabalho foram determinadas a sensibilidade e a especificidade da tecnica imunoenzimatica (ELISA) desenvolvida por CHAVEZ-OLORTEGUI et al. para detectar antigenos circulantes de veneno em pacientes picados por Tityus serrulatus. A media mais dois desvios padrao da observancia do soro de 100 pacientes controles foi utilizada como limite entre teste positivo e teste negativo ("cutoff"). A especificidade do ELISA foi igual a 97,0 por cento . A sensibilidade do metodo, quando incluidos pacientes classificados como casos leves, moderados e graves de escorpionismo, foi de 39,3 por cento e aumentou para 94,7 por cento quando considerados apenas os casos moderados e graves. Estes resultados mostram que o ELISA pode ser utilizado para deteccao de antigenos toxicos circulantes em pacientes com manifestacoes sistemicas de envenenamento escorpionico mas nao deve ser empregado no estudo de pacientes que apresentam apenas dor no local da picada (casos leves). O tempo necessario para a realizacao do ELISA e superior a 1 hora. Portanto, o teste tem sua utilizacao limitada para o diagnostico de envenenamento, mas pode construir um instrumento util para o estudo da cinetica de neutralizacao do veneno pelo antiveneno especifico.