Insect Venom Allergies: Is it Possible to Predict the Degree of Anaphylaxis?

In individuals who are allergic to Hymenoptera insect venom, the degree of anaphylaxis likely to result from an insect encounter cannot be predicted based on levels of venom-specific immunoglobulin E (IgE) or intracutaneous skin testing (ICT), according to study findings published in Journal of Asthma and Allergy.

The venom of Hymenoptera (insect order comprising wasps, bees, and ants) can produce severe anaphylaxis. However, biomarkers for predicting the occurrence of high-grade anaphylaxis have yet to be identified. Researchers therefore sought to evaluate whether ICT results and certain lab tests – ie, serum levels of tryptase, total IgE, venom-specific IgE, IgG, and IgG4 – could predict the risk for developing high-grade anaphylaxis.

The researchers conducted a retrospective evaluation 194 patients who presented to the allergy division of a university medical center in Göttingen, Germany, between July 1990 and July 2011. All patients had undergone specific immune therapy (SIT) after presenting with allergies to Vespid venoms (Vespula spp., Vespa spp., Polistes spp.; N=169, 87.1%), bee venoms (Apis mellifera, Bombus spp.; N=24, 12.4%), or both (N=1, 0.5%).

Significantly lower levels of venom-specific IgE and IgG were observed in patients diagnosed with grade IV anaphylaxis. These same patients trended toward elevated tryptase levels. Those patients who previously experienced grade IV anaphylaxis required greater doses of venom to yield positive ICTs than patients who showed lower grade responses. Researchers also observed no significant differences in average levels of venom-specific IgG4 and total IgE.

Study limitations included use of dissimilar test methods for patient evaluation, a lack of consistent criteria for ranking anaphylaxis symptoms, and the exclusion of patients who declined specific immune therapy (SIT).

The researchers concluded that “our findings based on a comparatively large cohort of venom-allergic individuals reveal that it is virtually impossible to draw conclusions regarding the grade of anaphylaxis that will develop based on currently available skin and laboratory results.” They added that “novel and more effective procedures and parameters for the determination of the duration of a venom SIT are urgently needed.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Hollstein MM, Matzke SS, Lorbeer L, et al. Intracutaneous skin tests and serum IgE levels cannot predict the grade of anaphylaxis in patients with insect venom allergies. J Asthma Allergy. Published online July 7, 2022. doi:10.2147/JAA.S367272