Abstract

PESTANA, Letícia et al. Biomarkers of primary sensitization and cross-reactivity in patients allergic to Hymenoptera venom. Rev Port Imunoalergologia [online]. 2019, vol.27, n.2, pp.105-114. ISSN 0871-9721.  https://doi.org/10.32932/rpia.2019.03.008.

Background: Diagnostic tests in patients allergic to hymenoptera venom are often positive for bee (B), wasp (W) and Polistes (P) venom, being difficult to choose the appropriate immunotherapy. Aim: Methods: 124 patients with systemic reactions to Hymenoptera stings and 30 controls without history of reaction to insect stings were included. ST were performed with commercial extracts (CE) of (B), (W) and (P) venoms, as well as sIgE with the same extracts and recombinant allergens for Api m1, Ves v5 and Ves v1, and to Pol d5 and carbohydrate determinants (CCD). In patients with negative ST/sIgE, BAT was performed in six concentrations using both venoms. Results: Based on sIgE, 66 patients (53%) were polisensitized and 38 patients (31%) were monosensitized. In 20 patients (16%) ST and sIgE were negative. Of the 66 polisensitized patients, 32 (49%) had double sensitization, 23 (35%) revealed cross-reactivity and 11 (16%) had none recombinants allergens. sIgE to CCD was positive in 25 patients, all with double sensitization with CE, showing crossreactivity between species in 23. The 20 patients with negative ST/sIgE had also negative allergen recombinants. The specificity for the four components was high, since only a control had positive sIgE to Vesv1/Vesv5. BAT was performed in 5 patients to both venoms and it was positive in 3 for B venom. Conclusions: Recombinant allergens for bee and wasp venom sIgE complements the diagnosis of venom allergy, allowing discrimination between true double sensitization and crossreactivity, as well as a better selection of patients for VIT. BAT seems to be useful in cases of difficult diagnosis.

Keywords : Hymenoptera venom allergy; recombinant allergens; double sensitization; cross-reactivity; basophil activation test.

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