Double positivity to bee and wasp venom: Improved diagnostic procedure by recombinant allergen-based IgE testing and basophil activation test including data about cross-reactive carbohydrate determinants
Double positivity to bee and wasp venom: Improved diagnostic procedure by recombinant allergen-based IgE testing and basophil activation test including data about cross-reactive carbohydrate determinants
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DOI：
10.1016/j.jaci.2012.02.008
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发表时间：
2012-07-01
影响因子：
14.2
通讯作者：
Ring, Johannes
中科院分区：
文献类型：
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作者：
Eberlein, Bernadette;Krischan, Lilian;Ring, Johannes
背景：针对蜜蜂和黄蜂毒液的特异性 IgE (sIgE) 抗体可能是由于对两种昆虫毒液的敏感性或交叉反应性碳水化合物决定簇 (CCD) 造成的。目的：研究使用两种毒液以及菠萝蛋白酶和辣根过氧化物酶 (HRP) 进行的嗜碱性粒细胞活化试验 (BAT) 或基于重组过敏原的 IgE 测试是否可以改进诊断程序。方法：研究人员对 22 名具有针对蜜蜂和黄蜂毒液的 sIgE 抗体的膜翅目毒液过敏患者进行了研究。测定了针对 MUXF3 CCD、菠萝蛋白酶、HRP、rApi m 1 和 rVes v 5 的 sIgE 抗体，并使用毒液提取物、菠萝蛋白酶和 HRP 进行了 BAT (Flow2 CAST)。如果需要，可以使用 ELISA 进行进一步的基于重组过敏原的 IgE 测试。根据半最大刺激时的昆虫毒液浓度计算嗜碱性粒细胞的反应性。结果：在12/1/9名患者中观察到rApi m 1和rVes v 5的双阳性/双阴性/单阳性。在最后的实验中，进一步基于重组过敏原的 IgE 测试显示，除一例外，所有案例中的其他毒液均呈阳性结果。 BAT 在 6/2/14 名患者中呈双阳性/双阴性/单阳性。 4 名 CCD sIgE 抗体呈阴性结果的患者，BAT 呈阳性结果。含有菠萝蛋白酶/HRP 的 BAT 显示出 50%/81% 的敏感性和 91%/90% 的特异性。结论：成分分辨 IgE 测试阐明了双重阳性的模式，显示了大多数独立于 CCD 致敏的真正双重致敏。即使由于诊断刺痛挑战的伦理限制，BAT 的真正临床相关性尚未完全确定，BAT 似乎也增加了有关罪魁祸首昆虫的更多信息。 BAT 与 HRP 是确定 CCD 敏感性的好方法。 （《过敏临床免疫杂志》2012 年；130：155-61。）
Background: Specific IgE (sIgE) antibodies to both bee and wasp venom can be due to a sensitivity to both insect venoms or due to cross-reactive carbohydrate determinants (CCDs).Objective: Investigating whether a basophil activation test (BAT) with both venoms as well as with bromelain and horseradish peroxidase (HRP) or recombinant allergen-based IgE testing can improve the diagnostic procedure.Methods: Twenty-two Hymenoptera-venom allergic patients with sIgE antibodies to both bee and wasp venom were studied. sIgE antibodies to MUXF3 CCD, bromelain, HRP, rApi m 1, and rVes v 5 were determined, and a BAT (Flow2 CAST) with venom extracts, bromelain, and HRP was performed. Further recombinant allergen-based IgE testing was done by using an ELISA, if required. The reactivity of basophils was calculated from the insect venom concentration at half-maximum stimulation.Results: Double positivity/double negativity/single positivity to rApi m 1 and rVes v 5 was seen in 12/1/9 patients. Further recombinant allergen-based IgE testing in the last ones revealed positive results to the other venom in all cases except one. BAT was double positive/double negative/single positive in 6/2/14 patients. Four patients with negative results in sIgE antibodies to CCDs had positive results in BAT. BAT with bromelain/HRP showed a sensitivity of 50%/81% and a specificity of 91%/90%.Conclusion: Component-resolved IgE testing elucidates the pattern of double positivity, showing a majority of true double sensitizations independent of CCD sensitization. BAT seems to add more information about the culprit insect even if the true clinical relevance of BAT is not completely determined because of ethical limitations on diagnostic sting challenges. BAT with HRP is a good method to determine sensitivity to CCDs. (J Allergy Clin Immunol 2012;130:155-61.)