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  Authority of Polish Society of Allergology

vol 13. no 4. December 2008  

 Original articles
Step-wise approach to the diagnosis of Hymenoptera venom allergy
Ewa Smorawska-Sabanty, Marek L. Kowalski

Introduction. Patients with generalised reactions to hymenoptera stings require a complex allergological diagnosis due to the risk of another reaction, and the possibility of an effective immunotherapy.
Aim of the study. This study attempts to compare the usefulness of a medical history of allergy and specific serum IgE in vitro determination, with the use of skin tests, for the diagnosis of hymenoptera venom allergy.
Material and methods. The study included 272 patients with a hypersensitivity reaction to a hymenoptera sting (wasp or bee). In addition to a clinical characterisation, the patients were subjected to a step-wise allergological diagnosis, including determinations of specific serum IgE levels (in all the patients), as well as epidermal and intradermal skin tests with wasp and/or bee allergens, in justified cases.
Results. Specific IgE antibodies to wasp and/or bee venom allergens were found in the serum of 60.3% patients (≥class 2). In patients without sIgE in their serum or with a doubtful medical history, skin testing confirmed an allergy in 89.9% of subjects sensitive to wasp venom and in 61.1. % of subjects sensitive to bee venom. Serum sIgE antibodies to wasp (but not bee) venom allergens were much more often present in patients with a generalised reaction to a sting compared to patients with a local reaction. The highest number of sIgE-positive results was observed within the first year after a sting, with a gradual decrease in the number of positive results, especially 5 years after the sting. However, no significant differences in the number of positive skin tests to insect venom were observed with regard to the time that elapsed between a reaction to a sting and the performance of tests. In patients with a biphasic reaction, a positive skin prick test to wasp or bee venom occurred much more often in comparison with patients with a monophasic reaction.
Conclusions. Our studies have shown that a complete diagnosis of allergy to hymenoptera venom requires not only in vitro determination of specific IgE, but in justified cases, it should be supplemented with skin testing.

keywords: alergia na jad owadów, osy, pszczoły, swoiste IgE, testy skórne, reakcja dwufazowa, insect sting allergy, bee, wasp, specific IgE, skin testing, biphasic reaction

pages: from 227 to 241

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