Fatal anaphylaxis following a hornet sting in a yellow jacket venom-sensitized patient with undetected monoclonal mast cell activation syndrome and without previous history of a systemic sting reaction

Blank, Simon; Pehlivanli, Sinan; Methe, Heiko; Schmidt‐Weber, Carsten B.; Biedermann, Tilo; Horny, Hans‐Peter; Kristensen, Thomas Kielsgaard; Amar, Yacine; Köberle, Martin; Brockow, Knut; Stömmer, P

doi:10.1016/j.jaip.2019.06.021

Cited by 13 publications

(8 citation statements)

References 8 publications

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“…Systemic symptoms may affect the skin (itching, urticaria, angioedema), respiratory (stridor, dyspnea, cough, bronchial obstruction), cardiovascular (hypotension, tachycardia, arrhythmias, cardiac arrest), gastrointestinal (vomiting, stomach pain, diarrhea), or even nervous system (dizziness, fear of death, fainting)— Figure 1 [ 4 ]. Fatal reactions are rare [ 5 ], but Hymenoptera stings cause 20% of cases of anaphylaxis-related fatalities [ 6 ]. Hymenoptera venom allergy is therefore a life-threatening allergy, and all patients who develop systemic symptoms after the sting require a detailed diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Hymenoptera Venom Allergy: State of the Art, Challenges, and Perspectives

et al. 2022

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Hymenoptera venom allergy is the most common cause of anaphylaxis in adults and the second-most frequent in children. The proper diagnosis of this life-threatening allergy remains a challenge. This review focuses on the current knowledge regarding diagnostics of Hymenoptera venom allergy. The paper includes a brief description of the representatives of Hymenoptera order and the composition of their venoms. Then, diagnostic tests for allergy to Hymenoptera venom are described. Common diagnostic problems, especially double positivity in tests for IgE antibodies specific to honeybee and wasp venom, are also discussed. Special attention is paid to the search for new diagnostic capabilities using modern methodologies. Multidimensional molecular analysis offers an opportunity to characterize changes in body fluids associated with Hymenoptera venom allergy and yields a unique insight into the cell status. Despite recent developments in the diagnostics of Hymenoptera venom allergy, new testing methodologies are still needed to answer questions and doubts we have.

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Section: Introductionmentioning

confidence: 99%

Diagnosis of Hymenoptera Venom Allergy: State of the Art, Challenges, and Perspectives

et al. 2022

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“…In allergic individuals, already a single sting can lead to severe and fatal reactions (19). These IgE mediated reactions depend on an initial step of sensitization.…”

Section: Ige-mediated Systemic Reactionsmentioning

confidence: 99%

Precision Medicine in Hymenoptera Venom Allergy: Diagnostics, Biomarkers, and Therapy of Different Endotypes and Phenotypes

et al. 2020

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Allergic reactions to stings of Hymenoptera species may be severe and are potentially fatal deviations of the immunological response observed in healthy individuals. However, venom-specific immunotherapy (VIT) is an immunomodulatory approach able to cure venom allergy in the majority of affected patients. An appropriate therapeutic intervention and the efficacy of VIT not only depend on a conclusive diagnosis, but might also be influenced by the patient-specific manifestation of the disease. As with other diseases, it should be borne in mind that there are different endotypes and phenotypes of venom allergy, each of which require a patient-tailored disease management and treatment scheme. Reviewed here are different endotypes of sting reactions such as IgE-mediated allergy, asymptomatic sensitization or a simultaneous presence of venom allergy and mast cell disorders including particular considerations for diagnosis and therapy. Additionally, phenotypical manifestations of venom allergy, as e.g. differences in age of onset and disease severity, multiple sensitization or patients unsusceptible to therapy, are described. Moreover, biomarkers and diagnostic strategies that might reflect the immunological status of the patient and their value for therapeutic guidance are discussed. Taken together, the increasing knowledge of different disease manifestations in venom hypersensitivity and the growing availability of diagnostic tools open new options for the classification of venom allergy and, hence, for personalized medical approaches and precision medicine in Hymenoptera venom allergy.

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“…is less, they still exhibit pronounced cross-reactivity. The clinical relevance of this cross-reactivity is reflected by the fact that patients primary sensitized to YJV can develop severe, and even fatal, anaphylaxis after a hornet sting and vice versa and, moreover, that hornet-allergic patients can be adequately treated with yellow jacket VIT [2,28]. However, one study from Italy (where Vespa crabro extract is available for VIT) suggests that in patients with ascertained primary Vespa allergy, VIT with V. crabro venom would be more adequate, at least concerning the safety profile [29].…”

Section: Antigen 5 Homologs In Different Species and Their Antigenic mentioning

confidence: 99%

“…Systemic reactions to the venoms of stinging Hymenoptera may be restricted to generalized symptoms of the skin, but can also affect the respiratory and vascular system and lead to multiorgan failure. Fatal anaphylaxis after Hymenoptera stings is a rare but well-recognized cause of sudden death [2] and accounts for approximately 20% of cases of anaphylaxis-related fatalities [3]. Hymenoptera venom allergy can be effectively treated by venom-specific allergen immunotherapy (VIT), which represents the only available curative treatment.…”

Section: Introductionmentioning

confidence: 99%

Antigen 5 Allergens of Hymenoptera Venoms and Their Role in Diagnosis and Therapy of Venom Allergy

Blank

Bazon

Grosch

et al. 2020

Curr Allergy Asthma Rep

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Purpose of Review Stings of Hymenoptera of the superfamily Vespoidea such as yellow jackets, paper wasps or stinging ants are common triggers for severe and even fatal allergic reactions. Antigen 5 allergens are potent allergens in the majority of these venoms with major importance for diagnosis and therapy. Reviewed here are the characteristics of antigen 5 allergens, their role in component-resolved diagnostics as well as current limitations of the available diagnostics for proper therapeutic decisions. Recent Findings Antigens 5 are proteins of unknown function in Hymenoptera venoms with high allergenic potency. They represent key elements in component-resolved diagnosis to discriminate between honeybee and vespid venom allergy. However, due to their pronounced cross-reactivity, there are remaining diagnostic and therapeutic challenges that have to be addressed. Summary Antigens 5 are highly relevant venom allergens of the Vespoidea superfamily. Although their use in componentresolved diagnosis facilitates dissection of cross-reactivity and primary allergy in double sensitization to honeybee and vespid venom, new diagnostic concepts are needed to discriminate between allergies to different vespid species.

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Fatal anaphylaxis following a hornet sting in a yellow jacket venom-sensitized patient with undetected monoclonal mast cell activation syndrome and without previous history of a systemic sting reaction

Cited by 13 publications

References 8 publications

Diagnosis of Hymenoptera Venom Allergy: State of the Art, Challenges, and Perspectives

Diagnosis of Hymenoptera Venom Allergy: State of the Art, Challenges, and Perspectives

Precision Medicine in Hymenoptera Venom Allergy: Diagnostics, Biomarkers, and Therapy of Different Endotypes and Phenotypes

Antigen 5 Allergens of Hymenoptera Venoms and Their Role in Diagnosis and Therapy of Venom Allergy

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