Key Issues in Hymenoptera Venom Allergy: An Update.

In this review, the Hymenoptera Allergy Committee of the SEAIC analyzes the most recent scientific literature addressing problems related to the diagnosis of hymenoptera allergy and to management of venom immunotherapy. Molecular diagnosis and molecular risk profiles are the key areas addressed. The appearance of new species of hymenoptera that are potentially allergenic in Spain and the associated diagnostic and therapeutic problems are also described. Finally, we analyze the issue of mast cell activation syndrome closely related to hymenoptera allergy, which has become a new diagnostic challenge for allergists given its high prevalence in patients with venom anaphylaxis.

Key issues in hymenoptera venom allergy: an update

In this review, the Hymenoptera Allergy Committee of the SEAIC analyzes the most recent scientific literature addressing problems related to the diagnosis of hymenoptera allergy and to management of venom immunotherapy. Molecular diagnosis and molecular risk profiles are the key areas addressed. The appearance of new species of hymenoptera that are potentially allergenic in Spain and the associated diagnostic and therapeutic problems are also described. Finally, we analyze the issue of mast cell activation syndrome closely related to hymenoptera allergy, which has become a new diagnostic challenge for allergists given its high prevalence in patients with venom anaphylaxis (AU)

En esta revisión el Comité de Alergia a Himenópteros de la SEAIC ha analizado la literatura científica más reciente sobre los principales problemas diagnósticos de la alergia a himenópteros, así como sobre las dificultades que pueden surgir durante la inmunoterapia con venenos. Se revisan especialmente las novedades relacionadas con el diagnóstico molecular y los perfiles moleculares de riesgo. También se describe la alergia a himenópteros poco habituales y los problemas diagnósticos y terapéuticos que esta conlleva. Por último, se tratan los síndromes de activación mastocitaria clonal, íntimamente relacionados con la alergia a himenópteros, que se han convertido en un nuevo reto diagnóstico para el alergólogo (AU)

Insect Venom Immunotherapy: Analysis of the Safety and Tolerance of 3 Buildup Protocols Frequently Used in Spain.

INTRODUCTION: Hymenoptera venom immunotherapy (VIT) is an effective treatment but not one devoid of risk, as both local and systemic adverse reactions may occur, especially in the initial phases. We compared the tolerance to 3 VIT buildup protocols and analyzed risk factors associated with adverse reactions during this phase. MATERIALS AND METHODS: We enrolled 165 patients divided into 3 groups based on the buildup protocol used (3, 4, and 9 weeks). The severity of systemic reactions was evaluated according to the World Allergy Organization model. Results were analyzed using exploratory descriptive statistics, and variables were compared using analysis of variance. RESULTS: Adverse reactions were recorded in 53 patients (32%) (43 local and 10 systemic). Local reactions were immediate in 27 patients (63%) and delayed in 16 (37%). The severity of the local reaction was slight/moderate in 15 patients and severe in 13. Systemic reactions were grade 1-2. No significant association was found between the treatment modality and the onset of local or systemic adverse reactions or the type of local reaction. We only found a statistically significant association between severity of the local reaction and female gender. As for the risk factors associated with systemic reactions during the buildup phase, we found no significant differences in values depending on the protocol used or the insect responsible. CONCLUSIONS: The buildup protocols compared proved to be safe and did not differ significantly from one another. In the population studied, patients undergoing the 9-week schedule presented no systemic reactions. Therefore, this protocol can be considered the safest approach.

[Ciliary changes with abscence of dynein arms in Kartagener's syndrome]. / Alteración ciliar con ausencia de los brazos de dineina en el síndrome de Kartagener.

A 33 years-old female with a diagnosis of Kartagener's syndrome was studied. She had a clinical history of chronic sinusitis with nasal obstruction and rhinorrea, and a chronic cough with mucopurulent sputum. A paranasal sinus CT showed hypertrophyc mucosa. A thoracic CT showed a situs inversus and chronic bronchitis with bronchiectasis. The saccharin test lasted 55 minutes. The electron microscopy study showed in a a cross-sectional axoneme a total absence of the outer and inner arm of the 9th outer doublet in over a 100 cilias studied. No others ultrastructure anormalities were observed.

Alteración ciliar con ausencia de los brazos de dineina en el síndrome de Kartagener / Ciliary changes with abscence of dynein arms in Kartagener's syndrome

Presentamos el caso de una mujer de 33 años diagnosticada de síndrome de Kartagener. La paciente refiere una historia de rinorrea y obstrucción nasal de larga evolución sugestiva de sinusitis crónica y de tos acompañada de expectoración mucopurulenta. En TC de senos paranasales se aprecia una mucosa sinusal hipertrófica. En TC de tórax de observa un situs inversus y bronquiectasias. El tiempo del test de la sacarina fue de 55 minutos. El estudio ciliar con microscopío electrónico mostró una ausencia completa de los dos brazos del doblete número nueve en más de 100 cilios estudiados. No se observaron otras alteraciones ultraestructurales (AU)

A 33 years-old female with a diagnosis of Kartagener's syndrome was studied. She had a clinical history of chronic sinusitis with nasal obstruction and rhinorrea, and a chronic cough with mucopurulent sputum. A paranasal sinus CT showed hypertrophyc mucosa. A thoracic CT showed a situs inversus and chronic bronchitis with bronchiectasis. The saccharin test lasted 55 minutes. The electron microscopy study showed in a a cross-sectional axoneme a total absence of the outer and inner arm of the 9th outer doublet in over a 100 cilias studied. No others ultrastructure anormalities were observed (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)