Improved diagnostics in double-positive insect venom patients

Published Online: March 15, 2012

It is estimated that more than half of the patients with hymenoptera venom allergy have positive diagnostic results to both bee and wasp venom. This poses the problem of identifying the relevant venom for immunotherapy especially when the patient has experienced only one anaphylactic reaction. Several studies have suggested that new component-resolved diagnosis using two or three recombinant allergens for IgE detection could facilitate the decision. On the other hand, studies using basophil activation tests showed promising results.

In a study in The Journal of Allergy and Clinical Immunology (JACI), Eberlein et al. analyzed 22 hymenoptera-venom allergic patients with sIgE-antibodies to both bee and wasp venom. Specific IgE-antibodies to several recombinant components of the venoms and cross-reactive carbohydrates (CCD) were determined. Furthermore a basophil activation test (BAT) with venom extracts and substances rich in carbohydrates was performed in a special manner measuring the reactivity of the cells (determination of half maximum allergen concentration).

The researchers found that expanded component resolved IgE testing elucidates the pattern of double positivity showing a majority of true double sensitizations. BAT added valuable information about the relevant insect species beyond determination of sIgE to recombinant allergens and was a good method to determine sensitivity to cross-reactive carbohydrate determinants.

Both methods together substantially facilitate the decision for the selection of insect venom species for allergen specific immunotherapy in patients with double positivity.


The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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