Abstract

Research Article

Higher venom-specific IgE levels differentiate children with previous local large reactions from children with previous systemic reactions of different severity

Pastorello Elide Anna*, Borgonovo Linda, Piantanida Marta, Schroeder Jan Walter, Pravettoni Valerio, Pastori Stefano, Bilo’ Maria Beatrice, Toniato Andrea, Aversano Maria Gloria, Farioli Laura, Nichelatti Michele and Preziosi Donatella

Published: 19 March, 2021 | Volume 5 - Issue 1 | Pages: 017-021

Introduction: Risk factors for systemic reactions (SRs) from hymenoptera venom (HV) allergy are well known in the adult population but they have been little studied in the pediatric one.

Method: The aim of our study was to identify risk factors for SRs in a population of children allergic to HV, comparing a series of clinical (age, gender, atopy, asthma) and laboratory (total IgE, tryptase, venom-specific IgE levels) variables between patients with at least two large local reactions (LLRs) and patients with SRs of different severity for the identified insect. We selected a population of HV allergic children aged < 15 years with LLRs or SRs stratified according to Mueller grades after stinging.

Results: The population included 80 children, 35 with at least 2 LLRs and 45 with SRs. The level of specific IgE for vespid (Polistes dominula, Vespula species) venoms was significantly higher (p = 0.0321) in children with SRs (Mueller grade II+III+IV) than in those with LLRs and the same significance was also found for specific IgE for Apis mellifera, considering SRs group (Mueller grade I+II+III+IV) in respect with LLRs group (p = 0.0001).

Conclusion: The main difference in our pediatric population was the highest level of specific IgE in children with a history of SRs compared to those with a history of LLRs for both vespids and honey bees. These results, once confirmed on a larger population, could suggest the opportunity to follow the behavior of venom specific IgE in children with LLRs to reveal a risk to develop future more serious reactions.

Read Full Article HTML DOI: 10.29328/journal.aaai.1001025 Cite this Article Read Full Article PDF

Keywords:

Hymenoptera venom; Large local reactions; Systemic reactions; Specific venom IgE; Children

References

  1. Mullins RJ, Dear KB, Tang ML. Time trends in Australian hospital anaphylaxis admissions in1998-1999 to 2011-2012. J Allergy Clin Immunol. 2015; 136: 367-375. PubMed: https://pubmed.ncbi.nlm.nih.gov/26187235/
  2. Turner PJ, Gowland MH, Sharma V, Ierodiakonou D, Harper N, et al. Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data. 1992-2012. J Allergy Clin Immunol. 2015; 135: 956-963. PubMed: https://pubmed.ncbi.nlm.nih.gov/25468198/
  3. Mullins RJ, Wainstein BK, Barnes EH, Liew WK, Campbell DE. Increases in anaphylaxis fatalities in Australia from 1997 to 2013 Clin Exp Allergy. 2016; 46: 1099-1110. PubMed: https://pubmed.ncbi.nlm.nih.gov/27144664/
  4. Grabenhenrich LB, Dölle S, Moneret-Vautrin A, Kohli A, Lange L, et al. Anaphylaxis in children and adolescents: The European Anaphylaxis Registry. J Allergy Clin Immunol. 2016; 137: 1128-1137. PubMed: https://pubmed.ncbi.nlm.nih.gov/26806049/
  5. Golden DB, Demain J, Freeman T, Graft D, Tankersley M, et al. Stinging insect hypersensitivity: A practice parameter update 2016. Ann Allergy Asthma Immunol. 2017; 118: 28-54. PubMed: https://pubmed.ncbi.nlm.nih.gov/28007086/
  6. Sturm GJ, Varga EM, Roberts G, Mosbech H, Bilò MB, et al. EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy. Allergy 2018; 73: 744-764. PubMed: https://pubmed.ncbi.nlm.nih.gov/28748641/
  7. Golden DB. Insect allergy in children. Curr Opin Allergy Clin Immunol. 2006; 6: 289-293.
  8. Bilò MB, Pravettoni V, Bignardi D, Bonadonna P, Mauro M, et al. Hymenoptera Venom Allergy: Management of Children and Adults in Clinical Practice. J Investig Allergol Clin Immunol. 2019; 29: 180-205. PubMed: https://pubmed.ncbi.nlm.nih.gov/30183660/
  9. Yavuz ST, Sahiner UM, Buyuktiryaki B, Soyer OU, Sakesen C, et al. Clinical features of children with venom allergy and risk factors for severe systemic reactions. Int Arch Allergy Immunol. 2013; 160: 313-321. PubMed: https://pubmed.ncbi.nlm.nih.gov/23095437/
  10. Graif Y, Romano-Zelekha O, Livne I, Green MS, Shohat T. Increased rate and greater severity of allergic reactions to insect sting among schoolchildren with atopic disease Pediatr Allergy Immunol. 2009; 20: 757-762. PubMed: https://pubmed.ncbi.nlm.nih.gov/19397756/
  11. Bilò MB, Martini M, Pravettoni V, Bignardi D, Bonadonna P, et al. Large local reactions to Hymenoptera stings: Outcome of re-stings in real life. Allergy 2019; 74(: 1969-1976. PubMed: https://pubmed.ncbi.nlm.nih.gov/31074868/
  12. Severino M, Bonadonna P, Passalacqua G. Large local reactions from stinging insects: from epidemiology to management. Curr Opin Allergy Clin Immunol. 2009; 9: 334-337. PubMed: https://pubmed.ncbi.nlm.nih.gov/19458526/
  13. Mueller HL. Diagnosis and treatment of insect sensitivity J Asthma Res. 1966; 3: 331-333. PubMed: https://pubmed.ncbi.nlm.nih.gov/4380730/
  14. Blum S, Gunzinger A, Muller UR, Helbling A. Influence of total and specific IgE, serum tryptase and age on severity of allergic reactions to Hymenoptera stings. Allergy. 2011; 66: 222-228. PubMed: https://pubmed.ncbi.nlm.nih.gov/20880144/
  15. Tripolt P, Arzt-Gradwohl, Cerpes U, Laipold K, Binder B, et al. Large local reactions and systemic reactions to insect stings: similarities and differences. Plos One. 2020; 16: 1-8.
  16. Soyygit S, Arslan S, Caliskaner AZ. Investigation of the factors that determine the severity of allergic reactions to hymenoptera venoms. Allergy and Asthma Proceedings. 2019; 40: 116-122. PubMed: https://pubmed.ncbi.nlm.nih.gov/30819281/
  17. Pastorello EA, Borgonovo L, Preziosi D, Schroeder JW, Pravettoni V, et al. Basal Tryptase high levels associated with a history of arterial hypertension and hipercholesterolemia represent risk factors for severe anaphylaxis in Hymenoptera venom Allergic subjects over 50 years old. Int Arch Allergy Immunol. 2020; 1-7. PubMed: https://pubmed.ncbi.nlm.nih.gov/33264768/
  18. Turner PJ, Jerschow E, Umasunthar T, Lin R, Campbell DE, et al. Fatal Anaphylaxis: Mortality Rate and Risk Factors J Allergy Clin Immunol Pract. 2017; 5: 1169-1178. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5589409/
  19. Farioli L, Losappio LM, Schroeder JW, Preziosi D, Scibilia J, et al. Basal tryptase levels can predict clinical severity in hymenoptera venom anaphylaxis and ischemic cardiovascular disorders J Investig Allergol Clin Immunol. 2019; 29: 162-164. PubMed: https://pubmed.ncbi.nlm.nih.gov/31017123/
  20. Solley GO. Stinging and biting insect allergy: an Auxtralian experience. Ann Allergy Asthma Immunol. 2004; 93: 532-537. PubMed: https://pubmed.ncbi.nlm.nih.gov/15609761/
  21. Sturm GJ, Heinemann A, Schuster C, Wiednig M, Groselj-Strele A, et al. Influence of total IgE levels on the severity of sting reactions in Hymenoptera venom allergy. Allergy. 2007; 62: 884-889. PubMed: https://pubmed.ncbi.nlm.nih.gov/17620065/
  22. Stebbings Jr JH. Immediate Hypersensitivity: a defence against arthropods? Perspect Biol Med. 1974; 17: 233-239. PubMed: https://pubmed.ncbi.nlm.nih.gov/4273175/
  23. Profet M. The function of allergy: Immunological defence against toxins. Q Rev Biol. 1991; 66: 23-62. PubMed: https://pubmed.ncbi.nlm.nih.gov/2052671/
  24. Mukai K, Tsai M, Starkl P, Marichal T, Galli SJ. IgE and mast cells in host defense against parasites and venoms. Semin Immunopathol. 2016: 38: 581-603. PubMed: https://pubmed.ncbi.nlm.nih.gov/27225312/
  25. Galli SJ, Starkl P, Marichal T, Tsai M. Mast cells and IgE in defense against venoms: possible “good side” of allergy? Allergol Int. 2016; 65: 3-15. PubMed: https://pubmed.ncbi.nlm.nih.gov/26666482/

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