Questionable diagnostic benefit of the commercially available panel of bee venom components

Abstract

For many years, only the major allergen rApi m 1 has been available on the ImmunoCAP system for routine diagnosis of bee venom (BV) allergy. Now, there are five components available, and we aimed to detect the sensitivity and specificity of rApi m 1, 2, 3, 5, and 10 in BV-allergic patients. We further evaluated the sensitivity of rApi m 1 and 2 of an alternative platform and investigated possible differences in the sensitization profile between monosensitization and clinically relevant double sensitization. Analysis of the whole panel of BV allergens of the CAP system still resulted in a lower sensitivity than analysis of the combination of rApi m 1 and 2 of the Immulite (71.6% vs 85.8%). Sensitization rate of rApi m 5 was more than doubled in double-sensitized patients, while there was no difference for rApi m 2. The benefit of the commercially available panel of BV components is questionable, due to the insufficient sensitivity and still unavailable important cross-reacting allergens.

Sensitization to Hymenoptera venom marker allergens: Prevalence, predisposing factors, and clinical implications

“…Our findings thus demonstrate a comparatively low sensitivity of IgE testing targeting recombinant BV components in BV-sensitized adults without sting-induced anaphylaxis even if the extended panel of commercially available BV allergens was used. This is in accordance with recent observations in patients with clinically relevant BV allergy 11. The observation of a higher rate of CCD-directed sensitization among BV-compared to VV-reactive subjects is likely to be related to a greater overlap with the double-sensitized group (see below) and might be attributed to a stronger glycosylation of BV allergens 15.…”

“…While greater proportions of subjects sensitized to rVes v 5 might be expected in a VV-allergic cohort, 8 Only 64.7% of BV-reactive subjects ( Figure 3B) were sensitized to one or several of the commercially available BV allergens. 11 The observation of a higher rate of CCD-directed sensitization among BV-compared to VV-reactive subjects is likely to be related to a greater overlap with the double-sensitized group (see below) and might be attributed to a stronger glycosylation of BV allergens. This is in accordance with recent observations in patients with clinically relevant BV allergy.…”

“…7 IgE testing targeting single venom marker allergens was recently introduced for routine diagnostic assessment of Hymenoptera venom-allergic patients: 2,3 Up to 90% of patients allergic to Vespula venom (VV) are considered to be sensitized to rVes v 5 8,9 and just under 60% to rVes v 1. 10 While sensitization to rApi m 1 is detectable in less than 80% of bee venom (BV)-allergic patients, depending on the test system used, 8,11,12 specific IgE testing targeting additional BV allergens has been proposed to increase diagnostic sensitivity. 10 While sensitization to rApi m 1 is detectable in less than 80% of bee venom (BV)-allergic patients, depending on the test system used, 8,11,12 specific IgE testing targeting additional BV allergens has been proposed to increase diagnostic sensitivity.…”

“…9 The use of a diagnostic cut-off of 0.10 kU A /L instead of the traditional threshold of 0.35 kU A /L has been proposed to further increase diagnostic sensitivity in patients with low total IgE levels and/or mastocytosis. 10 While sensitization to rApi m 1 is detectable in less than 80% of bee venom (BV)-allergic patients, depending on the test system used, 8,11,12 specific IgE testing targeting additional BV allergens has been proposed to increase diagnostic sensitivity. 12 Our study aims (a) to evaluate the prevalence of serological sensitization to BV and VV marker allergens in individuals without a history of sting-induced anaphylaxis, (b) to evaluate component-specific sensitization profiles in sera reactive to BV, VV, or both venoms, (c) to assess marker allergen-directed sensitization with regard to clinical and serological baseline parameters.…”

Immunological differences between insect venom‐allergic patients with and without immunotherapy and asymptomatically sensitized subjects

“…While changes in sIgG 4 to Ves v 5 were quite similar to those for the vespid extract, increases in sIgG 4 to Api m 1 were much weaker. This may be explained by the fact that bee venom consists of more allergen components than vespid venom, and also a broader IgE sensitization pattern is observed in bee venom allergy . Therefore, in bee venom‐allergic patients, IgG 4 is produced against several different allergens .…”