ABSTRACT
Although a serum sickness-like presentation has been reported as a sequela of Hymenoptera stings, the possible role of an immune complex-mediated pathologic condition in patients receiving regular venom immunotherapy has never been addressed. To evaluate this problem, 30 adult and 15 pediatric patients receiving regular monthly doses of venom (100 micrograms of antigen) were studied. All had been receiving immunotherapy for 12 to 29 mo. At the time of venom administration, a questionnaire related to symptoms of immune complex disease was completed. A urinalysis was performed 12 hr later. In addition, blood was drawn to evaluate the presence of immune complexes by Clq and Raji cell assays. Symptom surveys revealed no clinical manifestations suggestive of immune complex pathology. All urinalyses were negative for gross and microscopic hematuria. None of the specimens was elevated on the Clq assay. Only four of the 45 patients had significantly positive Raji cell assays. Prospective reevaluation showed the presence of immune complex before venom administration, with no change in acute-phase reactants or Raji cell titers 12 hr later. Monthly administration of Hymenoptera venom appears to be unassociated with immune complex-mediated disease, by either clinical or immunologic parameters.
Subject(s)
Bee Venoms/administration & dosage , Immune Complex Diseases/etiology , Immunotherapy/adverse effects , Insect Bites and Stings/therapy , Wasp Venoms/administration & dosage , Adolescent , Adult , Animals , Antigen-Antibody Complex/analysis , Antigen-Antibody Complex/metabolism , Complement Activating Enzymes/analysis , Complement C1q , Female , Humans , Immune Complex Diseases/immunology , Immunoglobulin E/biosynthesis , Immunoglobulin G/analysis , Long-Term Care , Middle Aged , Wasp Venoms/immunologyABSTRACT
Recently, significant gains have been made in the care of the patient allergic to stinging insects. Though epinephrine continues to be the drug of choice for the management of the anaphylactic reaction, newer delivery systems allow self-administration of the drug immediately following a sting to abort or attenuate a subsequent reaction. Patients most at risk, those with a history of life-threatening episodes of anaphylaxis following a sting, can be diagnosed and treated with the recently released Hymenoptera venoms with the expectation of excellent results. This success, however, has been accompanied by the frustration of not knowing the natural course of the disease in sufficient detail to counsel in cases of less dramatic insect hypersensitivity.
