Basophil activation in insect venom allergy: comparison of an established test using liquid reagents with a test using 5-color tubes with dried antibody reagents.

BACKGROUND: Flow cytometry-based basophil activation tests (BAT) have been performed with various modifications, differing in the use of distinct identification and activation markers. Established tests use liquid reagents while a new development involves the use of tubes with dried antibody reagents. The aim of this pilot study was to compare these two techniques in patients with insect venom allergy. METHODS: Seventeen patients with an insect venom allergy were included in the study. The established "BAT 1" utilizes conventional antibody solutions of anti-CCR3 for basophil identification and anti-CD63 to assess basophil activation, whereas "BAT 2" uses dried anti-CD45, anti-CD3, anti-CRTH2, anti-203c and anti-CD63 for identification and activation measurement of basophils. Negative and positive controls as well as incubations with honey bee venom and yellow jacket venom at three concentrations were performed. RESULTS: Seven patients had to be excluded due to low basophil counts, high values in negative controls or negative positive controls. For the remaining 10 patients the overall mean (± SD) difference in activated basophils between the two tests was 0.2 (± 12.2) %P. In a Bland-Altman plot, the limit of agreement (LoA) ranged from 24.0 to -23.7. In the qualitative evaluation (value below/above cut-off) Cohen's kappa was 0.77 indicating substantial agreement. BAT 2 took longer to perform than BAT 1 and was more expensive. CONCLUSION: The BAT 2 technique represents an interesting innovation, however, it was found to be less suitable compared to an established BAT for the routine diagnosis of insect venom allergies.

Hymenoptera venom immunotherapy: Safety and efficacy of an accelerated induction regimen with depot aluminum adsorbed extracts.

Introduction: Hymenoptera venom immunotherapy (VIT) is the only therapy that protects patients with Hymenoptera venom allergy by preventing systemic reactions after a new sting. Various extracts for VIT are available and used. VIT administration consists of an induction phase and a maintenance phase. Depot preparations of Hymenoptera VIT extracts are typically used for cluster and conventional protocols, and the maintenance phase. Many patients with Hymenoptera allergy need to achieve tolerance quickly because of the high risk of re-sting and possible anaphylaxis. Objective: Our study aimed to show the safety and efficacy of an accelerated regimen with depot preparations on aluminum hydroxide by using relatively high starting doses in a heterogeneous group of patients. Methods: The research focused on a group of patients with a history of severe systemic reactions to Hymenoptera stings, with the necessity of swift immunization due to high occupational risks. Aluminum hydroxide depot extracts either of Vepula species or Apis mellifera extracts were used. Results: The induction protocol was started with the highest concentration of depot venom extract of 100,000 standard quality unit and was well tolerated by 19 of 20 patients. Onne patient presented with a mild systemic reaction during the accelerated induction schedule, which was promptly treated with intravenous steroids and intramuscular H1 antihistamine; when switched to a conventional induction protocol, he had a similar reaction but finally reached maintenance with an H1-antagonist premedication. Conclusion: If validated, the accelerated induction protocol by using depot aluminum adsorbed extracts with the highest concentration of venom from the beginning could offer a streamlined and accessible treatment modality for patients diagnosed with anaphylaxis from bee and wasp venoms in need of rapid desensitization.

Efficacy and safety of hymenoptera venom immunotherapy.

Background: Being stung by Hymenoptera species can cause life-threatening anaphylaxis. Although venom immunotherapy (VIT) seems to be the most effective treatment, its long-term efficacy, and risk factors for adverse events remain unclear. Objective: The objective was to investigate the long-term efficacy of VIT and evaluate adverse events and risk factors related to this. Method: Patients who received VIT in a tertiary-care adult allergy clinic between January 2005 and July 2022 were included. Patients' data were compared with those of individuals who had been diagnosed with bee and/or wasp venom allergy during the same period but had not received VIT and experienced field re-stings. Results: The study included 105 patients with venom allergy, of whom 68 received VIT and 37 did not receive VIT. Twenty-three patients (34%) completed 5 years of VIT, and the overall mean ± standard deviation VIT duration was 46.9 ± 20.9 months. Re-stings occurred in 5 of 23 patients who completed 5 years of VIT, and none of them developed a systemic reaction. Eighteen patients (40%) experienced re-stings after prematurely discontinuing VIT, of whom eight (44%) developed a systemic reaction. In the control group of patients who did not receive VIT, 26 patients (70.3%) experienced re-stings, and all had systemic reactions (100%), with no change in their median Mueller scores. There was a significant difference in the median Mueller score change between the patients who received VIT and the controls who did not (p = 0.016). A total of 13 patients (19%) experienced adverse events while receiving VIT, which were systemic reactions in nine honeybee VIT. The use of ß-blockers was determined as the most important risk factor (odds ratio 15.9 [95% confidence interval, 1.2-208.8]; p = 0.035). Conclusion: It was confirmed that VIT was effective in both reducing the incidence and the severity of re-sting reactions. These effects were more pronounced in the patients who completed 5 years of VIT.

Helios-Negative Regulatory T Cells as a Key Factor of Immune Tolerance in Nonallergic Beekeepers

Background: Although exposure to stings has been identified as the leading risk factor for anaphylaxis due to Hymenoptera venom allergy, professional beekeepers receive hundreds of stings yearly without developing systemic reactions. Objective: This study aims to analyze the mechanisms underlying bee venom tolerance in beekeepers. Methods: A cross-sectional study was conducted. Participants were recruited and classified into 3 groups: allergic patients (APs), who experienced systemic reactions after bee stings, with a positive intradermal test and specific IgE (sIgE) to Apis mellifera venom (AmV); tolerant beekeepers (TBKs), who received ≥50 stings/year; and healthy nonexposed controls (HCs). We measured serum levels of sIgE and specific IgG4 (sIgG4) to AmV, rApi m 1, rApi m 2, rApi m 3, Api m 4, rApi m 5, and rApi m10, as well as AmV-induced basophil degranulation, percentage of T-cell subsets, regulatory T cells (Treg), and IL-10 production. Results: Compared with TBKs, APs had high levels of sIgE to AmV and all its allergic components (P<.001), together with a high basophil activation rate (P<.001). Conversely, compared with APs, TBKs had higher levels of sIgG4 (P<.001) and IL-10 (P<.0001), as well as an enhanced CTLA-4+ Treg population (P=.001), expanded Helios– Treg (P<.003), and reduced type 1 helper T cells (TH1) (P=.008), TH2 (P=.004), and TH17 (P=.007) subsets. Conclusions: The profile of TBKs, which was strongly marked by Treg activity, differed from that of TBKs. This natural tolerance would be led by the expansion of inducible Helios– Treg cells at the peripheral level. The Helios– Treg population could be a novel candidate biomarker for monitoring tolerance (AU)

Successful adaptation of bee venom ommunotherapy in a patient monosensitized to api m 10

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Total and honeybee venom-specific serum IgG4 and IgE in beekeepers

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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)

IgE-Api m 4 is useful for identifying a particular phenotype of bee venom allergy

Background and Objective: Different clinical behaviors have been identified in patients allergic to bee venom. Compound-resolved diagnosis could be an appropriate tool for investigating these differences. The aims of this study were to analyze whether specific IgE to Api m 4 (sIgE-Api m 4) can identify a particular kind of bee venom allergy and to describe response to bee venom immunotherapy (bVIT). Methods: Prospective study of 31 patients allergic to bee venom who were assigned to phenotype group A (sIgE-Api m 4 <0.98 kU/L), treated with native aqueous (NA) extract, or phenotype group B (sIgE-Api m 4 ≥0.98 kU/L), treated with purified aqueous (PA) extract. Sex, age, cardiovascular risk, severity of preceding sting reaction, exposure to beekeeping, and immunological data (intradermal test, sIgE/ sIgG4-Apis-nApi m 1, and sIgE-rApi m 2-Api m 4 were analyzed. Systemic reactions (SRs) during bVIT build-up were analyzed. Immunological and sting challenge outcomes were evaluated in each group after 1 and 2 years of bVIT. Results: Phenotype B patients had more severe reactions (P=.049) and higher skin sensitivity (P=.011), baseline sIgE-Apis (P=.0004), sIgE-nApi m 1 (P=.0004), and sIgG4-Apis (P=.027) than phenotype A patients. Furthermore, 41% of patients in group B experienced SRs during the build-up phase with NA; the sting challenge success rate in this group was 82%. There were no significant reductions in serial intradermal test results, but an intense reduction in sIgE-nApi m 1 (P=.013) and sIgE-Api m 4 (P=.004) was observed after the first year of bVIT. Conclusion: Use of IgE-Api m 4 as the only discrimination criterion demonstrated differences in bee venom allergy. Further investigation with larger populations is necessary (AU)

Antecedentes y Objetivos: Los pacientes alérgicos a veneno de abeja muestran distintos comportamientos clínicos. El diagnóstico por componentes podría ayudar a entenderlos. El objetivo de este estudio fue estudiar la capacidad de la IgE-Api m4 para identificar diferentes patrones de alergia al veneno de abeja, incluyendo la respuesta a la inmunoterapia al veneno de abeja (ITVa). Métodos: Estudio prospectivo de 31 pacientes alérgicos al veneno de abeja, distribuidos en dos grupos fenotípicos (A y B) en función de sus niveles de IgE-Api m4 (punto de corte 0,98 kU/L) y tratados con extracto acuoso nativo (AN)-fenotipo A, o extracto acuoso purificado (AP)-fenotipo B. Se analizaron sexo, edad, riesgo cardiovascular, gravedad de la picadura, exposición y datos inmunológicos (intradermorreación, IgE e IgG4-Apis-nApi m1 e IgE-rApi m2-Api m4). Se analizó la seguridad en la fase de inicio de la ITVa, y la eficacia y cambios inmunológicos después de 1 y 2 años de ITVa. Resultados: El fenotipo-B mostró reacciones más graves con las picaduras (p=0,049), una mayor sensibilidad cutánea (p=0,011) y valores más elevados de IgE-Apis (p=0,0004), IgE-nApim1 (p=0,0004), e IgG4-Apis (p=0,027) que el fenotipo-A. Por otra parte, el 41% de los pacientes del fenotipo-B sufrió reacciones sistémicas durante el inicio con AN, con una tasa de protección del 82%. La respuesta cutánea no mejoró significativamente, y se comprobó la reducción intensa de IgE-nApi m1 (p=0,013) e IgE-Api m4 (p=0,004) desde el primer año de ITVa. Conclusión: El uso de la IgE-Api m4 como único criterio discriminativo ha podido confirmar que hay diferentes maneras de ser alérgico al Va. Se necesitan estudios en poblaciones más amplias (AU)

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)

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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Specific immunotherapy using Hymenoptera venom: systematic review / Imunoterapia específica com venenos de Hymenoptera: revisão sistemática

CONTEXT AND OBJECTIVE: The only effective treatment for patients who have severe reactions after Hymenoptera stings is venom immunotherapy. The aim of this study was to review the literature to assess the effects of venom immunotherapy among patients presenting severe reactions after Hymenoptera stings. DESIGN AND SETTING: Randomized controlled trials in the worldwide literature were reviewed. The manuscript was produced in the Discipline of Allergy and Clinical Immunology, Universidade de São Paulo (USP). METHODS: Randomized controlled trials involving venom immunotherapy versus placebo or only patient follow-up were evaluated. The risk of systemic reactions after specific immunotherapy was evaluated by calculating odds ratios (OR) and their 95 percent confidence intervals. RESULTS: 2,273 abstracts were identified by the keywords search. Only four studies were included in this review. The chi-square test for heterogeneity showed that two studies were homogeneous and could be included in a meta-analysis. By combining the two studies, the odds ratio became significant: 0.29 (0.10-0.87). However, analysis on the severity of the reactions after immunotherapy showed that the benefits may not be so significant because the reactions were mostly similar to or milder than the original reaction. CONCLUSIONS: Specific immunotherapy should be recommended for adults and children with moderate to severe reactions, but there is no need to prescribe it for children with skin reactions alone, especially if the exposure is very sporadic. On the other hand, the risk-benefit relation should always be assessed in each case.

CONTEXTO E OBJETIVO: O único tratamento eficaz para pacientes que têm reações graves após ferroada de Hymenoptera é a imunoterapia com veneno. O objetivo deste estudo foi rever a literatura para avaliar os efeitos da imunoterapia com veneno em pacientes com reações graves após ferroada de Hymenoptera. TIPO DE ESTUDO E LOCAL: Foram revisados na literatura mundial ensaios clínicos controlados e aleatórios. O manuscrito foi realizado na Disciplina de Alergia e Imunologia Clínica, Universidade de São Paulo (USP). MÉTODOS: Ensaios clínicos controlados e aleatórios envolvendo imunoterapia com veneno de Hymenoptera versus placebo ou apenas acompanhamento dos pacientes foram avaliados. Realizada imunoterapia específica, o risco de reações sistêmicas foi avaliado através de cálculo do "odds ratio" e intervalo de confiança de 95 por cento. RESULTADOS: 2.273 resumos foram identificados na busca pelas palavras chave. Apenas quatro estudos foram incluídos nesta revisão. O teste qui-quadrado de heterogeneidade mostrou que dois estudos foram homogêneos e puderam ser incluídos na metanálise. Ao combinar os dois estudos, o "odds ratio" passou a ser significativo: 0.29 (0.10-0.87). Entretanto, ao analisar a gravidade das reações ocorridas após a imunoterapia, observou-se que os benefícios podem não ser tão relevantes, pois as reações foram, na grande maioria, ou mais leves ou semelhantes à reação original. CONCLUSÕES: A imunoterapia específica deve ser recomendada para adultos e crianças com reações moderadas a graves, porém não há necessidade de prescrevê-la para as crianças apenas com reações cutâneas, especialmente se a exposição é muito esporádica. No outro lado, a relação risco-benefício deve ser sempre avaliada em cada caso.

Inmunoterapia con veneno de himenópteros: presentación de diez casos clínicos / Immunotherapy against hymenoptera venom: Report of ten patients

Background: Immunotherapy can be used to treat allergic reactions to insect stings, specially bees and wasps. Aim: To report the experience with immunotherapy with aqueous extracts of hymenoptera venoms (bees and wasps). Material and methods: Ten patients aged 6 to 58 years were treated in an allergy center of a University Clinical Hospital. The medical indication for this treatment was, in all patients, anaphylactic reactions after hymenoptera stings. Immunotherapy was carried out using standardized vaccines (Aqueous extracts Venomvac LETI, Spain), applied in a traditional protocol, with subcutaneous injections. This protocol had two phases: a buildup phase (between weeks 1 and 13) and a monthly maintenance phase, from the 13th week. The monthly maintenance dose was 100 fig of hymenoptera specific venom extract. Results: Six patients had adverse reactions of different severity, during the treatment protocols and all had a good response to immediate therapeutic measures. After these events, they followed the protocol without problems. Two patients, treated with bee vaccines, suffered an accidental bee sting during the maintenance phase and they developed only local reactions. Conclusions: The lack of adverse reactions to bee stings in these two patients indicates the acquisition of clinical tolerance.

Design of a modern liposome and bee venom formulation for the traditional VIT-venom immunotherapy

Traditional venom immunotherapy uses injections of whole bee venom in buffer or adsorbed in Al (OH)3 in an expensive, time-consuming way. New strategies to improve the safety and efficacy of this treatment with a reduction of injections would, therefore, be of general interest. It would improve patient compliance and provide socio-economic benefits. Liposomes have a long tradition in drug delivery because they increase the therapeutic index and avoid drug degradation and secondary effects. However, bee venom melittin (Mel) and phospholipase (PLA2) destroy the phospholipid membranes. Our central idea was to inhibit the PLA2 and Mel activities through histidine alkylation and or tryptophan oxidation (with pbb, para-bromo-phenacyl bromide, and/or NBS- N-bromosuccinimide, respectively) to make their encapsulations possible within stabilized liposomes. We strongly believe that this formulation will be nontoxic but immunogenic. In this paper, we present the whole bee venom conformation characterization during and after chemical modification and after interaction with liposome by ultraviolet, circular dichroism, and fluorescence spectroscopies.

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

Características clínicas das reações por venenos de Hymenoptera e valor diagnóstico da determinação de IgE sérica específica nas alergias provocadas por estes insetos / Clinical characteristics of Hymenoptera venom reactions and the value of specific serum IgE determination in the diagnosis of these insect allergies

A ordem Hymenoptera é constituída pelas abelhas, vespas e formigas. Alergias aos venenos desses insetos podem ocasionar reações graves, muitas vezes fatais. O Brasil possui poucos dados epidemiológicos sobre alergia aos himenópteros e há poucos estudos que avaliem as características da determinação de IgE sérica específica e o seu papel no diagnóstico da alergia a estes insetos. Este trabalho tem como objetivo estudar os pacientes com alergia a himenópteros, em relação a parâmetros clínicos e testar o valor diagnóstico do método utilizado para a determinação sérica de IgE específica, de acordo com os parâmetros de sensibilidade, especificidade, valores preditivo positivo e negativo./The Hymenoptera order is constituted by bees, wasps and ants. The insect venoms allergies could provoke severe reactions, many times fatal. Brazil has few epidemiologic data about Hymenoptera allergy and there are few studies about specific serum IgE determination characteristics and its role in these insect allergies diagnosis. The aims of the present study are to analyze the patients with Hymenoptera allergy history based on clinical parameters and analyze the diagnostic value of the method used in specific serum IgE determination considering sensitivity, specificity, positive and negative predictive values...