Social wasps in Spain: the who and where

Objective The objective of this study was to list the social vespids occurring in Spain, determine their presence in each region, and correlate the data with the vespids responsible for allergic reactions and their progression over time.Methods Insects distribution data were collected in two phases: from the southern half of Spain (2008–2012), and from the northern half of Spain (2016–2019). Data for the vespids were collected from the prescriptions of Hymenoptera venom immunotherapy (HVIT) at six Spanish hospitals in the years 2009 and 2019.Results Polistes dominula and Vespula germanica were the most widely distributed species. Vespa velutina was found to be present in a large part of northern Spain. During the 10 year period, the prescriptions of vespid VIT increased by 42.63%. The north of Spain saw a 3.61 fold greater predominance of prescriptions for Vespula (to some extent influenced by Vespa velutina allergy) whereas in central and southern Spain, there was a 3.97 fold greater predominance of prescriptions for Polistes.Conclusions It is the first study that compares the vespid distribution maps with VIT prescription. A noteworthy finding is the wide presence of Polistes dominula and Vespula germanica in Spain and the appearance of Vespa velutina allergy in the northern part of the country. Data of HVIT prescriptions reflect inter-regional variability with the predominance of Vespula (due to Vespula and Vespa) in the north and that of Polistes in the center and south of Spain (AU)

Anaphylaxis to Vespa velutina nigrithorax: Pattern of Sensitization for an Emerging Problem in Western Countries

Objective: To define the sensitization pattern of patients with anaphylaxis to Vespa velutina nigrithorax (VVN). Methods: We studied 100 consecutive Spanish patients with anaphylaxis to Hymenoptera venom and systematically determined specific IgE (sIgE) to whole venoms (Vespula species, Polistes dominula, Apis mellifera, Vespa crabro, and Dolichovespula maculata) and their molecular components (rApi m 1, rApi m 5, rApi m 10, rVes v 1, rVes v 5, rPol d 5, and cross-reactive carbohydrates). Specific IgE to VVN venom and its antigen 5 (nVesp v 5) were measured in a subsample. Results: Seventy-seven patients had anaphylaxis to VVN. Of these, only 16 (20.8%) reported previous VVN stings, but were stung by other Hymenoptera. Positive sIgE (>0.35 kUA/L) to each of the whole venoms was detected in >70% of patients (Vespula species in 100%). The components showing >50% positivity were rApi m 5 (51.4%), rPol d 5 (80.0%), and rVes v 5 (98.7%). This pattern was similar to that of Vespula species anaphylaxis (n=11) but different from that of A mellifera anaphylaxis (n=10). Specific IgE to nVesp v 5 was positive in all patients (n=15) with VVN anaphylaxis and was correlated with sIgE to both rVes v 5 (R=0.931) and rPol d 5 (R=0.887). Conclusions: VVN has become the commonest cause of Hymenoptera anaphylaxis in our area. Most cases report no previous VVN stings. Their sensitization pattern is similar to that of patients with anaphylaxis to other Vespidae. Specific IgE to antigen-5 from VVN, Vespula species, and P dominula are strongly correlated in patients with VVN anaphylaxis (AU)

Hymenoptera venom allergy among children in Italy: time for pediatricians to take action

Hymenoptera venom allergy (HVA) is one of the most frequent causes of anaphylaxis following a bee, vespid or ant sting. Real-life data regarding the management of HVA in children are lacking. To address this unmet need, we carried out a survey defining the current management of HVA in children among pediatric allergists in Italy. Educational investments on the improvement of the management of pediatric patients with HVA are urgently needed, and our analysis represents a relevant instrument in targeting a roadmap with this aim. The time for pediatric allergists to take action has come, and a task force from the Rare Allergic Diseases Commission of the Italian Society of Pediatric Allergy and Immunology is working on the topic to improve pediatricians' knowledge and optimize the care of these patients

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The method for selecting basophils might be determinant in the basophil activation test in patients with mastocytosis

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Wasp venom immunotherapy in a patient with immune-mediated inflammatory central nervous system disease: is it safe?

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Safety of ultrarush venom immunotherapy: comparison between children and adults

Background: The ultrarush protocol is an attractive approach in the buildup phase of venom immunotherapy (VIT-UR). However, the degree of risk of VIT-UR in children remains unknown. The objective of this study was to compare the safety of VIT-UR in children and adults. Methods: We performed a study based on prospectively gathered medical records of children and adults with hymenoptera venom allergy treated with VIT-UR in 3 allergy centers in Poland. Results: The study population comprised 134 children (mean [SD] age, 12.6 [3.7] years; males, 70.1%) and 207 adults (mean age, 42.4 [14.0] years; males, 47.8%). The number of children in the subgroups of bee venom (BV) allergy and wasp venom (WV) allergy were comparable, although sensitization to WV was more predominant in the adult group (70.1%). Skin reactivity to both venoms was more common in children than in adults (P<.001); however, children had higher concentrations of total IgE and specific IgE to BV (both P<.001). Systemic allergic reactions (VIT-SARs) occurred in 6.2% of the patients (3.7% in children and 7.7% in adults; nonsignificant). In adults, SARs occurred more frequently in patients treated with BV than WV extracts (21.4% vs 2.6%; P<.001). The same pattern was observed in children (7.2% vs 0%; P=.058). However, VIT-SARs to BV were less frequent in children than in adults (P=.034). Similarly, no significant relationship was noted between children and adults receiving WV VIT (2.6% vs 0%; nonsignificant). The severity of VIT-SAR did not differ between children and adults. Conclusions: VIT-UR is safer in children. Age below 18 is not a risk factor for VIT-SARs (AU)

Introducción: Los protocolos ultra rápidos son considerados de utilidad para realizar la fase de inicio de la inmunoterapia con venenos de himenópteros (VIT-UR). La seguridad de estos protocolos VIT-UR en los niños sigue siendo una cuestión debatida. El objetivo de este estudio fue comparar la seguridad de VIT-UR en niños y adultos. Métodos: Estudio prospectivo de seguimiento de la seguridad de la inmunoterapia en niños y adultos regularmente tratados con VIT-UR seguidos en tres unidades de alergia en Polonia. Resultados: En el estudio fueron incluidos un total de 134 niños (edad media de 12,6 años, SD 3,7; varones 70,1%) y 207 adultos (edad media 42,4 años, SD 14,0; 47,8% varones). El número de niños sensibilizados a veneno de abeja (BV) era comparable al de los sensibilizados a veneno de avista (WV), mientras que la sensibilidad al veneno de avispa prevaleció en el grupo de adultos (70,1%). Los niños con hipersensibilidad a venenos (HVA) mostraron menor reactividad cutánea a ambos venenos que los adultos con HVA (p <0,001) pero, por el contrario, en comparación con los adultos presentan concentraciones de IgE sérica total e IgE específica frente a BV (ambas p <0,001). Un 6,2% de todos los pacientes (3,7% de los niños y 7.7% de los adultos, NS) presentaron reacciones alérgicas sistémicas frente a la inmunoterapia con venenos (VIT-SAR). En los adultos, el SARS fueron más frecuentes en los pacientes tratados con BV que los tratados con WV (21,4% frente a 2,6% p <0,001). El mismo patrón se produjo en niños (7,2% vs 0%; p = 0,058). Sin embargo, las VIT-SAR frente a inmunoterapia con BV fueron menos frecuentes en los niños que en adultos (p = 0,034). Del mismo modo la frecuencia de reacciones frente a WV VIT fue menor en niños que en adultos pero sin diferencias significativas (0% vs 2,6%, NS). La gravedad de las VIT-SAR fue similar para niños y adultos. Conclusiones: Los protocolos VIT-UR son más seguros en los niños. Edad menor de 18 años no es un factor de riesgo de VIT-SAR (AU)

Component-resolved diagnosis in vespid venom-allergic individuals

BACKGROUND: Hymenoptera venom-allergic patients frequently present multiple sensitisations. OBJECTIVES: To define the allergic profile by components in wasp allergic patients. To study the usefulness of specific IgE to components in cases of double sensitisation. MATERIALS AND METHODS: Wasp allergic patients who needed Polistes and/or Vespula venom immunotherapy were included. Before immunotherapy and after two years of treatment the following specific IgE (sIgE) levels were measured:Apis mellifera, Vespula spp. Polistes spp., rVes V 5, rPol d 5, nVes V 5, nPol d 5, nVes V 1, nPol d 1, nApi m 1, nApi m 2 and peroxidase. Skin tests with venoms were performed. Based on the sIgE and the skin test results, Polistes and/or Vespula immunotherapy was administered. RESULTS: Thirteen patients were included. Double sensitisation to Polistes/Vespula was detected in eight patients. Sensitisation to rVes V 5 and rPol d 5 was found in two of eight cases, to nVes V 1 and nPol d 1 in eight of 13 cases, and to nVes V 5 and nPol d 5 in 2 of 13 cases. Three patients received double immunotherapy with both wasps. One patient was treated with Vespula and nine with Polistes. sIgE levels decreased after two years of treatment. In patients who showed double sensitisation but were treated with only one venom, sIgE to both venoms decreased. CONCLUSIONS: Components analysis can be useful to study double positivity. In case of doubt, double immunotherapy should be administered. Phospholipase was found to be a major allergen in our population

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Rabdomiólisis por múltiples picaduras de avispa asiática (Vespa velutina) / Asian black hornet (Vespa velutina) multiple stings and secondary rhabdomyolysis

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The analysis of Hymenoptera hypersensitive patients in Ankara, Turkey

Background Although there are some published data about the prevalence of honeybee and vespid venom allergy from Turkey, there has been no report about Hymenoptera venom immunotherapy practice. Our aim was to determine the characteristics of Hymenoptera venom hypersensitivity and venom immunotherapy practice in Ankara, Turkey. Methods Demographic and clinical data, intradermal test, and serum specific IgE results of 65 Hymenoptera venom allergic patients who were followed up in our department from February 2005 to August 2009 were analysed. Results Serum Vespula specific IgE class (p:0.02) and Apis specific IgE class were high (p<0.0001) and Apis intradermal test results were positive (p<0.001) in accordance with the patients’ history. However, intradermal test results with Vespula were not consistent with self-reported Hymenoptera type (p:0.15). While Apis specific IgE and intradermal test results were correlated with each other (rho: 0.59, p<0.0001), Vespula specific IgE and intradermal test results were not (rho: 0.2, p:0.17). Intradermal test against Vespula did not discriminate between Apis and Vespula hypersensitive patients. There were no significant differences when the grade of reaction and specific IgE and intradermal test results were compared between Apis and Vespula. Conclusions Vespula venom hypersensitivity was more common among our patients. However, intradermal tests with Vespula had limited diagnostic sensitivity and were not correlated with serum specific IgE. Based on our results and previous reports, we recommend that negative skin test responses, especially with Vespula, need further investigation(AU)

Hypersensitivity to Vespula and Polistes: can we tell the primary sensitization from the clinical history? / Hipersensibilidad a vespula y polistes: ¿se puede determinar la sensibilización predominante a partir de la historia clínica?

Objective: To study the relationship between theprimary sensitization to wasp venoms and the geographicaland seasonal circumstances of the anaphylaxis-induced sting.Methods: We performed a retrospective review of115 patients (age 10-80) who suffered a systemicreaction to a wasp sting. Season and type of locality(urban or rural) at the moment of the sting wererecorded. Serum specific IgE levels to venoms fromVespula and Polistes were measured, and a primarysensitization was determined to whichever genus ofwasp for which the highest class of specific IgE wasobserved. The primary sensitization in relation to thetype of locality and the season was assessed usingthe chi-square test.Results: Most reactions occurred in urban areas(67.8 %), and in the summer season (63.4 %). Mostpatients were sensitized to Vespula venom (94.8 %).Primary sensitization was to Vespula in 56.5 %, toPolistes in 10.4 %, and undetermined in 33 %. Thedistribution of geographical areas did not show significantdifferences in relation to primary sensitization(p > 0.05). Most patients with primary sensitization toVespula suffered the anaphylaxis-induced sting afterthe spring season, with a statistically significant result(p < 0.05).Conclusion: In our population, the probability ofVespula sting is higher than Polistes sting when thereaction occurs after spring. This finding can help usto identify the responsible vespid when the diagnostictests do not provide an accurate result

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Systemic reactions to wasp sting: is the clinical pattern related to age, sex and atopy?

Background: The aim of this study was to analyze the frequency of clinical features and the severity of systemic reactions to wasp stings, and to establish their relationship with mean age, sex, and atopy. Methods: We studied 115 patients who suffered an anaphylactic reaction to wasp sting and showed specific IgE to venoms from Vespula and/or Polistes. In all patients, age, sex and personal history of atopy were registered. Cutaneous, respiratory, cardiovascular and gastrointestinal involvement during the course of the reaction was investigated. Each patient was assigned a severity grade according to a simple two-grade classification based on Müller's criteria. Bivariable analysis was performed to analyze the associations among mean age, sex and atopy and the symptoms and severity of the reaction. Results: The mean age was 40.2 years. There were 60 males (52.2 %) and 55 females (47.8 %). Twenty-six patients (22.6 %) were atopic. The percentages of involved systems were as follows: skin 90.4 %, respiratory 54.8 %, cardiovascular 33.9 %, and gastrointestinal 21.7 %. Reactions were mild in 40.8 %, and severe in 59.1 %. The mean age was higher in patients without cutaneous symptoms (p < 0.05). Cardiovascular involvement was more frequent in males (p < 0.05). No other significant differences were found. Conclusion: The symptoms of systemic reactions to wasp venom most frequently involved the skin, while reactions without cutaneous involvement were more frequent in older patients. Cardiovascular involvement was more common in males. The clinical pattern was not determined by atopy and the variables studied were not related to severity

Fundamento: El propósito de este estudio es analizar la frecuencia de manifestaciones clínicas y la gravedad de las reacciones sistémicas a picadura de avispa, así como establecer su relación con la edad media, el sexo y la atopia. Métodos: Estudiamos 115 pacientes que han sufrido una reacción anafiláctica a picadura de avispa y que muestran IgE específica frente a venenos de Vespula y/o Polistes. En cada caso re registra la edad, el sexo y los antecedentes personales de atopia. Se investigó la presencia de afectación cutánea, respiratoria, cardiovascular y gastrointestinal en el curso de la reacción, y se asignó un grado de severidad mediante un sistema de clasificación en dos grados a partir de los criterios de Müller. Se realizó un análisis bivariante para relacionar la edad, el sexo y la atopia con los síntomas y la gravedad de la reacción. Resultados: La edad media fue de 40,2 años. Los varones eran 60 (52,2%) y las mujeres 55 (47,8%). Veintiséis pacientes (22,6%) eran atópicos. El porcentaje de afectación por sistemas fue como sigue: cutánea 90,4%; respiratoria 54,8%; cardiovascular 33,9%; gastrointestinal 21,7%. Las reacciones fueron leves en un 40,8% y graves en un 59,1%. La edad media fue superior en pacientes sin síntomas cutáneos (p>0,05) y la afectación cardiovascular resultó mas frecuente en varones (p>0,05). No se observaron otros hallazgos significativos. Conclusión: Se concluye que los síntomas más frecuentes de las reacciones sistémicas a veneno de avispa son los cutáneos, siendo las reacciones sin afectación cutánea más típicas de personas de edad avanzada. La presencia de síntomas cardiovasculares es más común en varones. La atopia no determina el cuadro clínico y la gravedad no se relaciona con las variables estudiadas

Anafilaxia por picadura de himenóptero: estudio de 113 casos / Anaphylaxis to hymenoptera sting: study of 113 patients

Fundamento y objetivo: El propósito de este trabajo es la descripción de las características clinicoepidemiológicas de las reacciones anafilácticas a picaduras de himenópteros, analizando los casos en función de la gravedad. Pacientes y método: Se ha realizado un estudio observacional descriptivo de pacientes con edades comprendidas entre 10 y 80 años que, tras experimentar una reacción sistémica consecutiva a picadura de himenóptero, presentan inmunoglobulina E específica frente a venenos de Apis, Vespula y/o Polistes. Se realizó una encuesta dirigida a conocer los antecedentes y las características de la reacción, y se establecieron 2 niveles de gravedad a partir de la clasificación de Müller. Se efectuó un análisis de relación de cada nivel con diversos factores: edad, sexo, atopia, tipo de reacciones previas, zona de picadura y evolución del cuadro. Resultados: Se incluyó a 113 pacientes (63 varones), con una edad media (desviación estándar) de 40,1 (15,9) años. Se identificó reacción a veneno de abeja en el 10,6% y de avispa en el 89,4%. La inmunoglobulina E fue positiva a Vespula en el 91,9%, a Polistes en el 71,4% y a Apis en el 28,7%. Un 50,4% de casos mostró sensibilización conjunta a Vespula y a Polistes. Presentaba antecedentes de atopia el 20,3%. Entre los 106 pacientes que recordaban picaduras previas, el 35,9% refería reacciones locales aumentadas y el 16,5% reacciones sistémicas. La zona de picadura más frecuente fue la extremidad superior (38,9%). Los síntomas más comunes fueron: prurito (77,8%), habones (57,5%), edema (54,8%), eritema (52,2%), mareo (51,3%) y disnea (49,5%). Presentó reacciones graves el 65,5% de los pacientes. La edad, el sexo, la atopia, el tipo de reacciones previas, la zona de picadura y el tiempo de resolución no se relacionaron de forma significativa con la gravedad. El tiempo de aparición del primer síntoma fue proporcionalmente menor en los casos graves (p < 0,05). Conclusiones: En la población estudiada se objetiva una elevada frecuencia de hipersensibilidad a veneno de avispa (género Vespula). Excepto por la inmediatez del cuadro, no han podido establecerse a priori otros datos asociados al grado de presentación

Background and objective: The purpose of this study was to describe the clinical and epidemiological features of anaphylactic reactions to hymenoptera stings, with a case-history analysis according to severity. Patients and method: We conducted an observational descriptive study of patients aged between 10 and 80 years who suffered a systemic reaction after hymenoptera sting. All of them showed specific serum IgE to venoms from Apis, Vespula and/or Polistes. A questionnaire including history of atopy, past reactions and characteristics of the reaction, was performed by individual interview. Anaphylactic reactions were classified into two levels of severity according to Müller's classification. An analysis of independence was carried out in order to relate each level with several factors: age, gender, atopy, type of previous reactions, area of sting and time sequence. Results: 113 patients were included (63 male; mean age [standard deviation]: 40.1 [15.9] years). Reactions were accounted for bee venom in 10.6% of patients, and wasp in 89.4%. Specific IgE was positive to Vespula in 91.9% of subjects, Polistes in 71.4%, and Apis in 28.7%. Furthermore, 50.4% were sensitive to both Vespula and Polistes. Personal history of atopy was found in 20.3%. Among the 106 patients who reminded previous stings, local large reactions were referred by 35.9% and systemic reactions by 16.5%. Upper limb was the most frequent area of sting (38.9%). Most common symptoms were: pruritus (77.8%), hives (57.5%), edema (54.8%), erythema (52.2%), dizziness (51.3%) and dyspnea (49.5%). Severe reactions occurred in 65.5% of patients. Age, gender, atopy, type of previous reactions, area of sting and restoration time were not significantly associated with severity. Time elapsed to first symptom was proportionally shorter in severe cases (p < 0.05). Conclusions: There is a high frequency of hypersensitivity to wasp venom (Vespula) in the studied population. Except for immediacy, severity-associated data could not be established

Distonía aguda tras picadura de avispa / Acute dystonia following a wasp sting

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Continuous immunotherapy for hymenoptera venom allergy using six month intervals

Background: Specific immunotherapy for hymenoptera venom allergy (venom immunotherapy [VIT]) is safe and effective. The duration of treatment is still open for discussion because there is no reliable routine test to determine the real risk of serious anaphylactic reactions. This prospective study, which spans more than 25 years, was conducted to ensure unlimited protection through continuous VIT. To reduce workload and cost, the maintenance interval was increased to 6 months without increasing the rate of adverse events. Only patients with continuous follow-up by our service were included in this study. Patients and methods: VIT was conducted in 176 patients (125 allergic to wasp venom, 20 to bee venom, 31 to both) over a mean of 7.14 years (1.16-25.49). Total and specific IgE were determined on a regular basis. Results: A total of 162 re-stings were reported. Of these, 154 produced a strictly local reaction, seven produced non-serious reactions and one produced a systemic reaction similar to that produced by the initial sting before VIT. Total and specific IgE diminished during VIT. Substantial adverse effects were rare and never life-threatening. The effects occurred during observation in the ward and were controlled according to the treatment protocol recommended by a German expert consensus meeting on the treatment of anaphylactoid reactions. VIT was terminated in only one patient due to recurrent adverse effects. Conclusion: Continuous VIT at 6-monthly maintenance intervals conferred permanent protection in patients allergic to bee and wasp venoms and was found to be a safe and effective alternative to current standard protocols

Antecedentes: La inmunoterapia al veneno de hymenopteros (ITVH) se considera segura y eficaz. La discusión sobre la duración del tratamiento está todavía abierta dado que no existe un método fiable para determinar el riesgo real de reacción anafiláctica grave. Este estudio prospectivo que abarca un periodo de 25 años, se llevó a cabo para asegurar la protección ilimitada de la ITVH con el intervalo entre dosis ampliado a 6 meses, que disminuía costes y esfuerzos y sin incremento del índice de reacciones adversas. Únicamente se incluyeron en el estudio a pacientes de nuestro servicio en fase de seguimiento. Pacientes y métodos: La inmunoterapia frente a venenos se llevó a cabo en 176 pacientes (125 alérgicos al veneno de avispa, 20 al veneno de abeja y 31 a ambos) durante una media de 7,14 años (1,16-25,49). La IgE, total y específica, se determinó de forma habitual. Resultados: Se comunicaron un total de 162 re-pi-caduras, 154 de ellas con reacciones estrictamente locales, 7 con reacciones menos que intensas y sólo 1 con una reacción comparable a la primera picadura antes de la ITVH. Tanto la IgE total como específica disminuyeron durante la ITVH. Lo importante sobre los efectos secundarios es que fueron poco habituales y nunca amenazaron la vida de los pacientes. Las reacciones se presentaron durante el periodo de observación en el servicio y se trataron según el protocolo recomendado por un grupo de expertos de Alemania tras una reunión de consenso sobre reacciones anafilácticas. Sólo 1 paciente abandonó el tratamiento con ITVH por repetidos efectos adversos. Conclusión: Se demostró una protección permanente en pacientes alérgicos al veneno de abeja y/o avispa con una inmunoterapia de continuación frente a venenos, administrada a intervalos de 6 meses que se consideró una alternativa segura y eficaz a los actuales protocolos utilizados de forma estándar

Detección de alergía a veneno de himenópteros, después de beber vino / No disponible

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Picaduras y mordeduras de animales / Animal sting and bites

En este tema tratamos las picaduras por artrópodos. Se hace referencia a las diferencias que existen entre las picaduras de avispas y abejas, comentando la composición de venenos y las diferentes reacciones locales y generales que provocan dichas picaduras. Se exponen además las picaduras-mordeduras producidas por escorpiones, arañas, garrapatas, y animales marinos con la clínica que provocan y el tratamiento que es necesario administrar. Por último, se incluyen las mordeduras por serpientes, haciendo referencia a los tipos de ofidios más frecuentes en Navarra, la forma de diferenciar la mordedura de culebras de las víboras, la diferente clínica que provocan, y el tratamiento a aplicar (AU)

Clustered schedules in allergen-specific immunotherapy

Background: Injective immunotherapy is traditionally performed with a build-up phase lasting 3 to 4 months. The costs, decreasing compliance from both patients and clinicians and inconveniences due to this schedule may be overcome using different schedules. Methods and results: A revision of the published papers with clustered schedules has been made. Attention has been focussed on tolerance and its relationships with relevant parameters such as kind of extract (aqueous or depot), allergens and their pharmaceutical presentation, schedule followed, use or not of a premedication, clinical manifestations of patients before treatment. For a better revision, papers dealing with clustered schedules have been divided into two groups. The first group includes 20 papers not designed to study the clustered schedule but using it to study other parameters affected by specific immunotherapy. The second group includes 9 papers specifically or mainly designed to study the clustered schedule. A huge difference in the rate of side effects could be assessed among different papers, even in studies run with similar allergens from the same producer and with a similar schedule. Conclusions: Summarizing the results of the revision, the following conditions seem to lead to the optimal tolerance of the clustered schedule: use of a premedication; use of a depot preparation; use of no more than 4 administrations per cluster; administration of 1-2 clusters per week and of 4 to 6 clusters in total. These results seem promising but further efforts are required to better define the optimal clustered schedule (AU)

Introducción: La inmunoterapia subcutánea conlleva una fase de incremento de dosis que dura de 3 a4 meses. El coste, la baja aceptación tanto de pacientes como de médicos y los inconvenientes debidos a este esquema convencional, pueden verse mejorados siguiendo pautas alternativas de tratamiento. Método y resultados: Se ha realizado una revisión de los trabajos publicados siguiendo esquemas cluster. La atención se ha centrado en la tolerancia y su relación con parámetros relevantes tales como tipo de extracto (acuoso o depot), alergenos y sus presentaciones farmacéuticas, pauta empleada, uso o no de premedicación y diagnóstico clínico de los pacientes estudiados. Para una revisión mejor, los tra-bajos que siguen pautas cluster han sido divididos en 2 grupos. El primer grupo incluye 20 trabajos no enfocados para el estudio de esquemas cluster sino para valorar otros parámetros relacionados con la inmunoterapia específica. El segundo grupo incluye 9 trabajos diseñados específicamente para estudiar pautas cluster. Se ha observado una gran variabilidad en la tasa de efectos adversos entre los diferentes trabajos, incluso en aquellos estudios desarrollados con alergenos similares producidos por un mismo fabricante y con una pauta similar. Conclusiones: Parece observarse que hay unos determinados factores que podrían influir en la tolerancia óptima de pautas cluster: uso de premedicación; empleo de extractos depot; administración inferior a 4 inyecciones por visita-cluster, pautas cluster con administraciones no superiores a 2 visitas por semana y de 4 a 6 visitas-cluster en total. Estos resultados parecen prometedores, pero se requiere más información para poder definir una pauta de cluster óptima (AU)

The safety and efficacy of immunotherapy with aluminum hydroxide-adsorbed venom extract of Vespula spp. An open, retrospective study

Background: specific immunotherapy for Hymenoptera Venom (VIT) is considered a life-saving treatment in insect sting allergy. A few studies with depot VIT have been published, but they are mainly focussed on patients sensitized to Apis. Methods: this retrospective study was designed to evaluate both efficacy and safety of depot VIT for Vespula. Thirty-six patients (age range 6-73 years) with a history of systemic reactions (grade III to IV according to Mueller) after a Vespula sting, and specific sera IgE RAST to Vespula at least class 2, were administered a depot preparation of venom reaching 50 μg as monthly maintenance dose. After the first year the maintenance dose was administered every other month. Thirty-three patients were treated for a minimum of 5 years. Reactions to any new field sting of the relevant insect were recorded during the treatment and for 6 to 24 months after its interruption.Results: the treatment showed an excellent tolerance, with only a few local side effects. Thirteen patients (11 Grade IV according to Mueller before VIT) under treatment showed only local reactions after each field sting (18 field stings in total) by the relevant insect. Four patients (3 Grade IV according to Mueller before VIT) had a total of 6 field stings after the interruption of the 5-year treatment, with only local reactions. Conclusions: according to our results, and in agreement with previous published studies, VIT for Vespula spp. with depot extracts has an excellent tolerance and is clinically effective (AU)

Antecedentes: la IT específica con Venenos de Himenópteros (ITV) se considera un tratamiento capaz de salvar la vida de personas alérgicas a picaduras de insectos. Se han publicado pocos estudios de ITV con extractos depot en su mayoría de pacientes sensibilizados a Apis.Métodos: este estudio retrospectivo se designó para evaluar tanto la eficacia como la seguridad de la ITV con extractos depot para Vespula. Treinta y seis pacientes (entre 6 y 73 años) con historia de reacciones sistémicas (grado III-IV de la escala de Mueller) por picadura de Vespula y con RAST al menos clase 2, fueron tratados con un extracto depot de veneno, alcanzando una dosis mensual de mantenimiento de 50 g. Después del primer año, la dosis de mantenimientro se administró cada 2 meses. Treinta y tres pacientes recibieron tratamiento durante un mínimo de 5 años. Durante la inmunoterapia y de 6 a 24 meses después de su interrupción, se registró cualquier reacción ocasionada por picadura del insecto estudiado.Resultados: el tratamiento mostró una excelente tolerancia, con únicamente alguna reacción local. Trece pacientes (11 grado IV de la escala de Mueller antes de la ITV) bajo tratamiento, mostraron sólo reacciones locales tras picadura de Vespula (18 picaduras en total). Cuatro pacientes (3 grado IV de la escala de Mueller antes de la ITV) tuvieron un total de 6 picaduras con sólo reacciones locales (1 picadura en 2 pacientes y 2 picaduras en 2 pacientes) una vez interrumpido el tratamiento de 5 años.Conclusiones: de acuerdo a los datos obtenidos, la ITV para Vespula con extractos depot tiene una excelente tolerancia y es clínicamente efectiva. Se precisarían estudios adicionales mayores para confirmar nuestros resultados (AU)

Dermografismo secundario a alergia a picadura de avispa / Secondary dermographism in wasp sting allergy

Se presenta el caso de una mujer de 55 años que inició dermografismo a partir de una picadura de avispa. Tenía antecedentes de reacción local gigante retardada y reacción sistémica grado I tras picadura de avispa y, en ese momento, las pruebas cutáneas y la IgE específica habían sido positivas para Polistes spp (intradermorreacción 1 µg/mL: 7x7/25x27 mm; 0,51 kU/L). Tres años más tarde, después de una picadura de avispa, inició dermografismo y los valores de IgE específica aumentaron de manera marcada (>100 kU/L). Al cabo de 5 meses persistían la clínica cutánea e idénticos valores de IgE específica. No se han encontrado casos descritos de dermografismo asociado a alergia a veneno de himenópteros. (AU)