CAP-Inhibition, Molecular Diagnostics, and Total IgE in the Evaluation of <b><i>Polistes</i></b> and <b><i>Vespula</i></b> Double Sensitization

Abstract

Cross-reactions between &lt;i&gt;Polistes dominula&lt;/i&gt; and &lt;i&gt;Vespula&lt;/i&gt; species are common in southern Europe. Currently, only CAP-inhibition demonstrates high accuracy in identifying genuine sensitizations, but this method is time-consuming and expensive, so a new approach is required. This study investigates skin tests, molecular diagnostics, total IgE (tIgE), and the Ves v 5/Pol d 5 (or vice versa) ratio. The ratio generated low-accuracy results and poor agreement with CAP-inhibition, and we did not find any agreement between CAP-inhibition test and double values of Ves v 5/Pol d 5. Nevertheless, a slight diagnostic improvement was obtained when Ves v 5/tIgE and Pol d 5/tIgE were measured.

Marker allergens in Hymenoptera venom allergy — Characteristics and potential use in precision medicine

“…This might result in unnecessary treatment with more than one or application of the wrong venom. Specific IgE inhibition assays with venom extracts [2] or cellular tests such as the basophil activation test (BAT) [3] can be helpful in many cases to confirm the diagnosis when skin tests or sIgE measurements show their limits. However, although recommended in the diagnostic guidelines, these tests are still not available for routine diagnostics in all clinics as the interpretation of results requires specific expertise.…”

Clinical aspects of hymenoptera venom allergy and venom immunotherapy

“…Other diagnostic tests are also useful to discriminate between cross-reactivity and multiple sensitizations, especially when CRD results are inconclusive. While CAP-inhibition is particularly useful in discriminating Vespula-Polistes double sensitization(49,52,54), BAT has several other applications; in fact, it can be used also as confirmation test in case of negative or inconclusive results of conventional diagnostic tests(56,57). However, both CAP-inhibition and BAT are reserved for selected situations, since both are time consuming, expensive and performed by selected laboratories only.…”

Shedding Light on the Venom Proteomes of the Allergy-Relevant Hymenoptera Polistes dominula (European Paper Wasp) and Vespula spp. (Yellow Jacket)

“…Limitations of the currently commercially available components for CRD to distinguish between YJV and PDV allergy in double-positive patients was demonstrated by the fact that a good accordance between antigen 5-based CRD and CAP-inhibition assays can only be achieved when the value of sIgE in kUA/L to Ves v 5 was about twice those to Pol d 5 and vice versa [57,58]. However, a later multicenter study did not find any agreement between CAP-inhibition test results and double sIgE values of Ves v 5 over Pol d 5 or vice versa [59]. Hence, the availability of additional cross-reactive major allergens of YJV and PDV for routine diagnostics such as PLA1 and DPP IV surely would add value for uncovering primary sensitization in vespid venom allergic patients and to distinguish true mono-from true double-sensitization.…”