Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Clinical and Molecular Allergy
Published in: Clinical and Molecular Allergy 1/2018

Open Access 01-12-2018 | Research

A 13-year real-life study on efficacy, safety and biological effects of Vespula venom immunotherapy

Authors: Marcello Albanesi, Andrea Nico, Alessandro Sinisi, Lucia Giliberti, Maria Pia Rossi, Margherita Rossini, Georgios Kourtis, Anna Simona Rucco, Filomena Loconte, Loredana Muolo, Marco Zurlo, Danilo Di Bona, Maria Filomena Caiaffa, Luigi Macchia

Published in: Clinical and Molecular Allergy | Issue 1/2018

Login to get access

Abstract

Background

Hymenoptera venom immunotherapy (VIT) is a clinically effective treatment. However, little is known about its long-term clinical efficacy and biological effects. Several mechanisms have been proposed to account for VIT efficacy, including reduction of specific IgE and induction of allergen-specific IgG4, but the overall picture remains elusive. We investigated Vespula VIT clinical efficacy up to 8 years after discontinuation and the kinetics of Vespula-specific IgE and IgG4. Out of 686 consecutive patients we retrospectively selected and analysed a series of 23 patients with Vespula allergy that underwent a 5-year IT course, followed by a prolonged follow-up.

Methods

Clinical efficacy of VIT was assessed as number and severity of reactions to Vespula re-stinging events. The presence of Vespula-specific IgE and IgG4 was also monitored over time.

Results

During the VIT treatment, patients were protected, reporting no reactions or mild reactions in occasion of re-stinging events. This protection was entirely maintained during the follow-up, up to 8 years. Skin reactivity (reflecting mast cell-bound Vespula-specific IgE) and circulating Vespula-specific IgE levels declined substantially during VIT. Notably, this reduction was maintained over time during the follow-up. Moreover, all the patients were analysed for IgG4. A robust induction of Vespula-specific IgG4 was observed during the VIT course, with a substantial decline during the follow-up.

Conclusions

We conclude that Vespula VIT is a clinically effective treatment, which induces long-term protection after discontinuation. The reduction of specific IgE, assessed by skin tests and RAST, closely matches the VIT- induced protection, while the IgG4 induction seems not to be associated with VIT clinical efficacy in the long term.
Appendix
Available only for authorised users
Literature
1.
Moffitt JE, et al. Stinging insect hypersensitivity: a practice parameter update. J Allergy Clin Immunol. 2004;114(4):869–86.CrossRefPubMed
2.
Bonifazi F, et al. Prevention and treatment of Hymenoptera venom allergy: guidelines for clinical practice. Allergy. 2005;60(12):1459–70.CrossRefPubMed
3.
4.
Keating MU, et al. Clinical and immunologic follow-up of patients who stop venom immunotherapy. J Allergy Clin Immunol. 1991;88(3):339–48.CrossRefPubMed
5.
Golden DB, et al. Discontinuing venom immunotherapy: outcome after five years. J Allergy Clin Immunol. 1996;97(2):579–87.CrossRefPubMed
6.
Golden DB, et al. Discontinuing venom immunotherapy: extended observations. J Allergy Clin Immunol. 1998;101(3):298–305.CrossRefPubMed
7.
Lerch E, Muller UR. Long-term protection after stopping venom immunotherapy: results of re-stings in 200 patients. J Allergy Clin Immunol. 1998;101(5):606–12.CrossRefPubMed
8.
Golden DB, et al. Outcomes of allergy to insect stings in children, with and without venom immunotherapy. N Engl J Med. 2004;351(7):668–74.CrossRefPubMed
9.
Hafner T, DuBuske L, Kosnik M. Long-term efficacy of venom immunotherapy. Ann Allergy Asthma Immunol. 2008;100(2):162–5.CrossRefPubMed
10.
Reisman RE. Duration of venom immunotherapy: relationship to the severity of symptoms of initial insect sting anaphylaxis. J Allergy Clin Immunol. 1993;92(6):831–6.CrossRefPubMed
11.
Oka T, et al. Rapid desensitization induces internalization of antigen-specific IgE on mouse mast cells. J Allergy Clin Immunol. 2013;132(4):922–932.e1–16.CrossRefPubMedPubMedCentral
12.
Zhao D, et al. The functional IgE-blocking factor induced by allergen-specific immunotherapy correlates with IgG4 antibodies and a decrease of symptoms in house dust mite-allergic children. Int Arch Allergy Immunol. 2016;169(2):113–20.CrossRefPubMed
13.
Gawlik R, et al. Effects of venom immunotherapy on serum level of CCL5/RANTES in patients with Hymenoptera venom allergy. Immunopharmacol Immunotoxicol. 2015;37(4):375–9.CrossRefPubMed
14.
Cavkaytar O, Akdis CA, Akdis M. Modulation of immune responses by immunotherapy in allergic diseases. Curr Opin Pharmacol. 2014;17:30–7.CrossRefPubMed
15.
Bruhns P, et al. Specificity and affinity of human Fcgamma receptors and their polymorphic variants for human IgG subclasses. Blood. 2009;113(16):3716–25.CrossRefPubMed
16.
17.
van der Neut Kolfschoten M, et al. Anti-inflammatory activity of human IgG4 antibodies by dynamic Fab arm exchange. Science. 2007;317(5844):1554–7.CrossRefPubMed
18.
19.
Müller UR. Insect sting allergy: clinical picture, diagnosis, and treatment. Stuttgart: Gustav-Fischer Verlag; 1990.
20.
Patriarca G et al. Sublingual desensitization in patients with wasp venom allergy: preliminary results. Int J Immunopathol Pharmacol. 2008;21:669–77.
21.
Corallino M, et al. Skin testing technique and precision in stinging insect allergy. J Clin Nurs. 2007;16(7):1256–64.CrossRefPubMed
22.
Macchia L, et al. Changes in skin reactivity, specific IgE and IgG levels after one year of immunotherapy in olive pollinosis. Allergy. 1991;46(6):410–8.CrossRefPubMed
23.
24.
Diane F, Jelinek I, James T. Immunoglobulin structure and functions. In: Franklin Adkinson N, Bochner B, Wesley Burks A, Holgate ST, Lemanske RF, editors. Middleton’s, allergy. Elsevier Saunders; 2014. 1: p. Chapter 3:30–45.
25.
Carr TF, Saltoun CA. Chapter 2: Skin testing in allergy. In: Allergy Asthma Proceedings. 2012. 33;1:S6–8.
26.
Golden DB. Insect sting anaphylaxis. Immunol Allergy Clin N Am. 2007;27(2):261–72.CrossRef
27.
Randolph CC, Reisman RE. Evaluation of decline in serum venom-specific IgE as a criterion for stopping venom immunotherapy. J Allergy Clin Immunol. 1986;77(6):823–7.CrossRefPubMed
28.
Pravettoni V, et al. Determinants of venom-specific IgE antibody concentration during long-term wasp venom immunotherapy. Clin Mol Allergy. 2015;13:29.CrossRefPubMedPubMedCentral
29.
Ginaldi L, et al. The immune system in the elderly: II. Specific cellular immunity. Immunol Res. 1999;20(2):109–15.CrossRefPubMed
30.
King TP, et al. Yellow jacket venom allergens, hyaluronidase and phospholipase: sequence similarity and antigenic cross-reactivity with their hornet and wasp homologs and possible implications for clinical allergy. J Allergy Clin Immunol. 1996;98(3):588–600.CrossRefPubMed
31.
King TP, et al. Protein allergens of white-faced hornet, yellow hornet, and yellow jacket venoms. Biochemistry. 1978;17(24):5165–74.CrossRefPubMed
32.
Frick M, et al. Predominant Api m 10 sensitization as risk factor for treatment failure in honey bee venom immunotherapy. J Allergy Clin Immunol. 2016;138(6):1663–71.CrossRefPubMed
33.
Blank S, et al. Api m 10, a genuine A. mellifera venom allergen, is clinically relevant but underrepresented in therapeutic extracts. Allergy. 2011;66(10):1322–9.CrossRefPubMed
34.
Baker TW, et al. The HIT study: Hymenoptera Identification Test—how accurate are people at identifying stinging insects? Ann Allergy Asthma Immunol. 2014;113(3):267–70.CrossRefPubMed
35.
Golden DB, et al. Natural history of Hymenoptera venom sensitivity in adults. J Allergy Clin Immunol. 1997;100(6):760–6.CrossRefPubMed
36.
Durham SR, Till SJ. Immunologic changes associated with allergen immunotherapy. J Allergy Clin Immunol. 1998;102(2):157–64.CrossRefPubMed
37.
Wuthrich B, Arrendal H, Lanner A. Antibody response pattern (specific IgE and IgG) of insect sting allergic patients in immunotherapy with venom preparations. Schweiz Med Wochenschr. 1981;111(46):1756–65.PubMed
38.
39.
Wong KJ, et al. IgE+ B cells are scarce, but allergen-specific B cells with a memory phenotype circulate in patients with allergic rhinitis. Allergy. 2015;70(4):420–8.CrossRefPubMed
40.
Pilette C, et al. Grass pollen immunotherapy induces an allergen-specific IgA2 antibody response associated with mucosal TGF-beta expression. J Immunol. 2007;178(7):4658–66.CrossRefPubMed
41.
Kerstan A, et al. Wasp venom immunotherapy induces activation and homing of CD4(+) CD25(+) forkhead box protein 3—positive regulatory T cells controlling T(H)1 responses. J Allergy Clin Immunol. 2011;127(2):495–501.CrossRefPubMed
42.
Nouri-Aria KT, et al. Grass pollen immunotherapy induces mucosal and peripheral IL-10 responses and blocking IgG activity. J Immunol. 2004;172(5):3252–9.CrossRefPubMed
43.
Ozdemir C, et al. Mechanisms of immunotherapy to wasp and bee venom. Clin Exp Allergy. 2011;41(9):1226–34.CrossRefPubMed
44.
Adjobimey T, Hoerauf A. Induction of immunoglobulin G4 in human filariasis: an indicator of immunoregulation. Ann Trop Med Parasitol. 2010;104(6):455–64.CrossRefPubMedPubMedCentral
45.
Akdis CA, Akdis M. Mechanisms of allergen-specific immunotherapy and immune tolerance to allergens. World Allergy Organ J. 2015;8(1):17.CrossRefPubMed
46.
Akdis M, Akdis CA. Mechanisms of allergen-specific immunotherapy: multiple suppressor factors at work in immune tolerance to allergens. J Allergy Clin Immunol. 2014;133(3):621–31.CrossRefPubMed
47.
Varga EM, et al. Time course of serum inhibitory activity for facilitated allergen-IgE binding during bee venom immunotherapy in children. Clin Exp Allergy. 2009;39(9):1353–7.CrossRefPubMed
Metadata
Title
A 13-year real-life study on efficacy, safety and biological effects of Vespula venom immunotherapy
Authors
Marcello Albanesi
Andrea Nico
Alessandro Sinisi
Lucia Giliberti
Maria Pia Rossi
Margherita Rossini
Georgios Kourtis
Anna Simona Rucco
Filomena Loconte
Loredana Muolo
Marco Zurlo
Danilo Di Bona
Maria Filomena Caiaffa
Luigi Macchia
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Clinical and Molecular Allergy / Issue 1/2018
Electronic ISSN: 1476-7961
DOI
https://doi.org/10.1186/s12948-017-0079-y

Other articles of this Issue 1/2018

Clinical and Molecular Allergy 1/2018 Go to the issue

Research

Role of genetic variations of chitinase 3-like 1 in bronchial asthmatic patients

Review

A critical appraisal on AIT in childhood asthma

Review

Involvement of miR-126 in autoimmune disorders

Research

Low incidence of pneumonia in COPD patients treated with inhaled corticosteroids undergoing pulmonary rehabilitation

Case report

A case of atopic dermatitis caused by Ascaris lumbricoides infection

Research

Hymenoptera sting reactions in southern Italy forestry workers: our experience compared to reported data