RESUMEN
Cross-reactions between Polistes dominula and Vespula species are common in southern Europe. Currently, only CAP-inhibition demonstrates high accuracy in identifying genuine sensitizations, but this method is time-consuming and expensive, so a new approach is required. This study investigates skin tests, molecular diagnostics, total IgE (tIgE), and the Ves v 5/Pol d 5 (or vice versa) ratio. The ratio generated low-accuracy results and poor agreement with CAP-inhibition, and we did not find any agreement between CAP-inhibition test and double values of Ves v 5/Pol d 5. Nevertheless, a slight diagnostic improvement was obtained when Ves v 5/tIgE and Pol d 5/tIgE were measured.
Asunto(s)
Alérgenos/inmunología , Anafilaxia/diagnóstico , Reacciones Cruzadas , Desensibilización Inmunológica/métodos , Hipersensibilidad/diagnóstico , Mordeduras y Picaduras de Insectos/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Niño , Europa (Continente) , Femenino , Humanos , Inmunización , Inmunoglobulina E/sangre , Masculino , Persona de Mediana Edad , Patología Molecular , Reproducibilidad de los Resultados , Pruebas Cutáneas , Ponzoñas/inmunología , Avispas/inmunología , Adulto JovenRESUMEN
BACKGROUND: Venom immunotherapy (VIT) is a highly effective treatment but can induce systemic adverse effects. OBJECTIVE: To evaluate the safety and tolerability of VIT with purified and nonpurified extracts for treating yellow jacket and honeybee allergy. METHODS: Ninety-four patients (mean age, 46 years) with a history of insect venom allergy were randomly allocated to undergo purified extract VIT (group A [44 patients]) or nonpurified extract VIT (group B [50 patients]). Fifty-six patients were allergic to yellow jacket venom (group A: 25; group B: 31) and 38 to honeybee (19 per group). The induction phase was performed using a 2- or 7-day ultrarush scheme. The maintenance phase lasted 11 weeks. Local and systemic reactions were recorded after each injection. RESULTS: A total of 1,401 VIT injections were performed. Six systemic reactions were observed in 4 patients (honeybee-allergic patients only) (4% of patients; 0.4% of injections): 1 patient in group A (2%) and in 3 in group B (6%) (P = .57). Local extensive reactions were recorded after 5 injections in 4 patients (9%) in group A (2 yellow jacket- and 2 honeybee-allergic patients) and after 17 injections in 12 patients (24%) in group B (8 yellow jacket- and 4 honeybee-allergic patients) (P = .02). Total reactions (systemic and large local) numbered 6 in group A (0.9% of injections; 11% of patients) and 20 in group B (2.7% of injections; 30% of patients) (P = .001). CONCLUSION: In patients with honeybee or yellow jacket venom allergy, VIT with purified extracts has a significantly lower propensity toward severe local reactions compared with VIT with nonpurified extracts.