Component-resolved diagnosis of vespid venom-allergic individuals: phospholipases and antigen 5s are necessary to identify Vespula or Polistes sensitization.

BACKGROUND: Cross-reactivity between hymenoptera species varies according to the different allergenic components of the venom. The true source of sensitization must therefore be established to ensure the efficacy of venom immunotherapy. OBJECTIVE: In the Mediterranean region, Polistes dominulus and Vespula spp. are clinically relevant cohabitating wasps. A panel of major vespid venom allergens was used to investigate whether serum-specific IgE (sIgE) could be used to distinguish sensitization to either vespid. METHODS: Fifty-nine individuals with allergic reactions to vespid stings and positive ImmunoCAP and/or intradermal tests to vespid venoms were studied. sIgE against recombinant and natural venom components from each wasp species was determined using the ADVIA Centaur(®) system. RESULTS: sIgE against recombinant antigen 5s sensitization to be detected in 52% of the patients tested (13/25). The sensitivity increased to 80% (20/25), when using natural antigen 5s, and to 100% with the complete panel of purified natural components, because the sIgE was positive to either the antigen 5s (Pol d 5/Ves v 5) or to the phospholipases (Pol d 1/Ves v 1) of the two vespids, or to both components at the same time. In 69% of cases, it was possible to define the most probable sensitizing insect, and in the rest, possible double sensitization could not be excluded. Vespula hyaluronidase was shown to have no additional value as regards the specificity of the assay. CONCLUSIONS: The major allergens of P. dominulus' and Vespula vulgaris' venom, namely phoshpholipases and antigen 5s, are required to discriminate the probable sensitizing species in vespid-allergic patients.

¿Cuál es el resultado de una vacunación con alérgeno en un paciente no sensibilizado? A propósito de un caso / Which is the effect of an allergen vaccine administration to a non-sensitized patient? One case reported

Presentamos un caso anecdótico de una paciente con anafilaxia por sensibilización alérgica a veneno de Vespula y con estudio alergológico al veneno de abeja negativo, a la que accidentalmente se trató con inmunoterapia de veneno de abeja mediante una pauta tradicional. A partir de la cuarta dosis administrada, se observaron reacciones locales inflamatorias tardías que alteraron su calidad de vida de forma importante. Esto obligó a ralentizar la pauta de administración. Tras 2 meses de tratamiento, con un total de 8 dosis administradas del extracto, se detectó el error y se repitió el estudio alergológico al veneno de abeja; se observó que se habían positivizado tanto las pruebas cutáneas como la determinación de IgE específica sérica. Se informó a la paciente de su sensibilización al veneno de abeja desencadenada por la administración del extracto erróneo y se inició la vacunación con un extracto de avispa, que se toleró desde las primeras dosis. Actualmente, casi 5 años después de haberse suspendido la inmunoterapia errónea, la paciente mantiene un estudio alergológico positivo, con concentraciones de IgE específica sérica estables en los últimos 4 años

We present an anecdotic case of a patient who suffered from an anaphylactic reaction after a wasp sting and with positive allergy study to wasp venom and negative to bee venom, who was submitted unintentionally to bee venom immunotherapy by conventional protocol. From the fourth dose, the patient suffered from large local late reactions with impairment of her quality of life, which induce us to change the administration protocol. After two months of the beginning of immunotherapy administration, with a total of 8 doses received, the mistake was detected and immediately an allergy study to bee venom was performed. This study become positive in skin tests and in the specific IgE determination. The patient was informed about the mistaken bee venom immunotherapy, and about the induction of hypersensitivity to bee venom, and she was treated with wasp venom immunotherapy with good tolerance since the first dose. Nowadays, nearly 5 years after interruption of the erroneous immunotherapy, the patient keeps with a positive allergy study to bee venom, remaining without changes in the last 4 years

Reacciones tardías en las pruebas cutáneas con penicilina: correlación con la anamnesis / Late reactions to penicillin skin tests: correlation with history

Antecedentes y objetivos: La utilidad de las pruebas cutáneas en el diagnóstico de la alergia a las penicilinas está bien demostrada; sin embargo, no siempre existe una buena relación entre la anamnesis y el resultado de estas pruebas. Casos clínicos: Se presentan tres pacientes en los que la anamnesis, ya por el tiempo de aparición de la reacción, ya por el tipo de lesión, sugiere una hipersensibilidad inmediata o acelerada con posible participación de la IgE; las pruebas cutáneas fueron positivas de forma muy tardía, entre 2 y 3 semanas después de su aplicación. Conclusión: No siempre existe un patrón clínico que permita predecir el resultado de las pruebas cutáneas por lo que aconsejamos realizar el estudio alergológico aún cuando la sospecha de hipersensibilidad sea baja

Background and objectives: The useful of skin tests in diagnosis of penicillin allergy is well known; however, there is not always a good correlation between history and results from these tests. Cases: Three cases are presented in which the history, due to the time of appearance or the type of lesions, suggests an potentially IgE-mediated immediate or accelerated hypersensitivity; skin tests were positive very late, between 2 and 3 weeks after their application. Conclusion: There is not always a clinic pattern which permits to predict results of skin tests, so we recommend to perform the allergy study even with a low index of suspicion