Predictors of the severity of honeybee venom allergy

Published online: August 1, 2021

Stings by Hymenopteran insects can cause life threating systemic allergic reactions (SARs). Venom immunotherapy (VIT) is the only effective treatment to prevent further SARs; however, during VIT, patients can also develop severe systemic adverse events. Baseline SAR severity and adverse events during VIT are likely interconnected. Determining specific risk factors that could identify individuals at high risk for either would advance current management by improving selection of patients for VIT and by aiding in selection of the most appropriate schedule, type, and duration of VIT.

Kopač and colleagues in the recent issue of The Journal of Allergy and Clinical Immunology: In Practice examined different clinical parameters (including gender, age and the use of cardiovascular medications) and immunological factors (baseline serum tryptase levels; specific IgE (sIgE) to HB venom, rApi m 1 and rApi m 10; and basophil activation test with honey-bee venom) in 332 venom-allergic patients undergoing honeybee VIT to determine if they can serve as predictors of the above events.

Two hundred and six (62%) patients experienced severe sting reactions (Ring and Messmer Scale III-IV), while 126 (38%) patients experienced non-severe sting reactions (Ring and Messmer Scale I-II). Factors associated with severity of the reaction were older age, baseline tryptase and basophil activation level after stimulation with specific allergen. Systemic adverse events during VIT were evident in 26.8% of patients and the occurrence of adverse events was again associated with baseline tryptase and basophil activation level which predicted the possibility of an adverse event independently of one another.

The basophil response reflected through the proportion of activated basophils in response to in vitro allergen stimulation, and the mast cell burden, reflected via baseline tryptase levels, are major and independent predictors of the severity of sting reactions and SAEs during VIT in patients with honeybee venom allergy. These risk factors may be important to identify patients at high risk of a severe/life-threatening reaction and can help guide recommendations for the selection of the most appropriate and safe schedule of venom immunotherapy

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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