Epileptic attacks associated with wasp sting-induced anaphylaxis.

We report the case of a patient who suffered two epileptic attacks, each one associated with an anaphylactic shock due to wasp venom. He had no history of atopy nor any known diseases. Previous wasp stings had been well tolerated. An IgE-mediated hypersensitivity to the venom was shown both by cutaneous and immunologic tests. Specific IgE against Polistes spp. venom was 0.86 kU/I (RAST method), and intradermal tests with Polistes spp. venom were positive at a concentration of 1 microgram/ml. Cutaneous tests and serum specific IgE against Vespula spp. and Apis mellifera venoms were negative. In addition to that, wasp venom immunotherapy has been a highly effective treatment. Although convulsions may occur as a complication of anaphylaxis, only a few cases have been reported in the literature because of wasp venom. In our patient, it seems more likely that the epileptic attacks were due to anoxemia due to hypotension caused by vasodilatation and cardiac involvement in anaphylaxis.

Monoclonal antibody-standardized cat extract immunotherapy: risk-benefit effects from a double-blind placebo study.

Twenty-eight patients (14 in an active treatment group and 14 in a placebo group) with rhinoconjunctivitis and asthma caused by cat hypersensitivity took part in a placebo-controlled, randomized, double-blind study to evaluate the risk-benefit quotient of the maintenance dose corresponding to 13.2 micrograms Fel d I antigen. The cat extract was biologically standardized and quantified with monoclonal antibodies (100 biological units: 33 microgram of Fel d I antigen, 650 micrograms of albumin, and 99 micrograms of Fel d Bd/K30 antigen). After 1 year of treatment, the systemic reactions to cat extract immunotherapy were mild and infrequent. Improvement was observed in the active treatment group in comparison with the placebo group in the medication-symptoms score (p < 0.001); in skin prick test (p < 0.001), conjunctival provocation test (p < 0.001), and allergen bronchoprovocation test (p < 0.05) results, and in nonspecific bronchial hyperreactivity measured with methacholine, which was not statistically significant. This study demonstrates the favorable risk-benefit quotient of the dose of 13.2 micrograms of Fel d I antigen, which may serve as a future reference in defining the optimum dose and appropriate proportion of antigens that should be administered in cat extract immunotherapy.