Component-resolved diagnosis in selecting patients for yellowjacket venom immunotherapy

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http://hdl.handle.net/10138/300967

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Kukkonen , A K , Pelkonen , A S , Edelman , S M , Kauppi , P M & Mäkelä , M J 2018 , ' Component-resolved diagnosis in selecting patients for yellowjacket venom immunotherapy ' , Annals of Allergy, Asthma, & Immunology , vol. 120 , no. 2 , pp. 184-189 . https://doi.org/10.1016/j.anai.2017.11.012

Title: Component-resolved diagnosis in selecting patients for yellowjacket venom immunotherapy
Author: Kukkonen, Anna Kaarina; Pelkonen, Anna Susanna; Edelman, Sanna Marika; Kauppi, Paula Maria; Mäkelä, Mika Juhani
Contributor: University of Helsinki, Clinicum
University of Helsinki, Department of Dermatology, Allergology and Venereology
University of Helsinki, Clinicum
University of Helsinki, Department of Dermatology, Allergology and Venereology
University of Helsinki, Clinicum
Date: 2018-02
Language: eng
Number of pages: 6
Belongs to series: Annals of Allergy, Asthma, & Immunology
ISSN: 1081-1206
URI: http://hdl.handle.net/10138/300967
Abstract: Background: Venom immunotherapy is effective in preventing systemic allergic reactions (SARs), but the diagnosis of venom allergy is problematic. Objective: To compare the performance of component-resolved diagnosis and conventional tests in patients referred for venom immunotherapy. Methods: We measured serum-specific immunoglobulin E to yellowjacket and honeybee venoms (Ves v 1 and Ves v 5 and Api m 1), cross-reactive carbohydrate determinants, serum basal tryptase (ImmunoCAP, ThermoFisher Scientific, Uppsala, Sweden), and skin prick test reactions in 84 patients referred to receive venom immunotherapy. History of SAR and its severity were evaluated. Results: Of the 78 patients with suspected yellowjacket venom (YJV) allergy, a history of SAR was confirmed in 47 (60%) and 31 (40%) had a non-SAR reaction. The most accurate tests to confirm venom allergy after a SAR were serum-specific immunoglobulin E to yellowjacket whole-venom extract spiked with Ves v 5 (area under the curve 0.87, 95% confidence interval 0.77-0.97, P <.001) and Ves v 5 (area under the curve 0.86, 95% confidence interval 0.76-0.96, P <.001). Sensitization to Ves v 1 was infrequent and its area under the curve was low (0.62, 95% confidence interval 0.47-0.76, P = .106). Sensitivity of the YJV skin prick test was 86%, but its specificity was low at 54%. Double sensitization to yellowjacket and honeybee occurred frequently in skin prick tests. Of the patients without a SAR, 26% showed a positive reaction to YJV in any serum test and 46% showed a positive reaction in skin tests. Conclusion: Specific immunoglobulin E to the YJV spiked with Ves v 5 confirmed the allergy after a SAR. A history of SAR should be confirmed before testing, because venom sensitization is frequent in other types of reactions. (C) 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
Subject: BASOPHIL ACTIVATION TEST
RVES V 5
API M 1
RECOMBINANT ALLERGENS
STING REACTIONS
SERUM TRYPTASE
VESPULA VENOM
WASP VENOM
IGE
SENSITIZATION
3121 General medicine, internal medicine and other clinical medicine
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