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. 2017;26(3):93-105.
doi: 10.1007/s40629-017-0014-2. Epub 2017 Apr 11.

Diagnostics in Hymenoptera venom allergy: current concepts and developments with special focus on molecular allergy diagnostics

Thilo Jakob  1   2 , David Rafei-Shamsabadi  1 , Edzard Spillner  3 , Sabine Müller  1
Affiliations

Diagnostics in Hymenoptera venom allergy: current concepts and developments with special focus on molecular allergy diagnostics

Thilo Jakob et al. Allergo J Int. 2017.

Abstract

Background: The high rate of asymptomatic sensitization to Hymenoptera venom, difficulty in correctly identifying Hymenoptera and loss of sensitization over time make an accurate diagnosis of Hymenoptera venom allergy challenging. Although routine diagnostic tests encompassing skin tests and the detection of venom-specific IgE antibodies with whole venom preparations are reliable, they offer insufficient precision in the case of double sensitized patients or in those with a history of sting anaphylaxis, in whom sensitization cannot be proven or only to the presumably wrong venom.

Methods: Systematic literature research and review of current concepts of diagnostic testing in Hymenoptera venom allergy.

Results and discussion: Improvements in diagnostic accuracy over recent years have mainly been due to the increasing use of molecular allergy diagnostics. Detection of specific IgE antibodies to marker and cross-reactive venom allergens improves the discrimination between genuine sensitization and cross-reactivity, and this provides a better rationale for prescribing venom immunotherapy. The basophil activation test has also increased diagnostic accuracy by reducing the number of Hymenoptera venom sensitizations overlooked with routine tests. This paper reviews current concepts of diagnostic testing in Hymenoptera venom allergy and suggests fields for further development.

Keywords: Basophil activation test; Diagnostic algorithm; Recombinant allergens; Skin test; cross-reactive carbohydrate determinants.

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Conflict of interest statement

T. Jakob has received research grants and speakers honoraria from Thermo Fischer/Phadia Freiburg, Germany and Uppsala, Sweden in addition to research support from ALK-Abello, Allergy Therapeutics, Allergopharma, Cormetics Europe and Novartis. D. Rafei-Shamsabadi declares that he has no competing interests. E. Spillner is co-founder of PLS-Design. S. Müller has received speakers honoraria from Novartis, Bencard and Travel reimbursement from ALK Abello.

Figures

Fig. 1
Fig. 1
Honeybee and yellow jacket venom and their respective marker and cross-reactive allergens. Apis mellifera marker allergens: Api m 1, 3, 4 and 10; Apis mellifera potentially cross-reactive allergens: Api m 2, 5 and 12. Vespula vulgaris marker allergens: Ves v 1 and 5; Vespula vulgaris potentially cross-reactive allergens: Ves v 2, 3 and 6. HVB honeybee venom, YJV yellow jacket venom, Api m 1 Apis mellifera allergen number 1, Ves v 1 Vespula vulgaris allergen number 1
Fig. 2
Fig. 2
Recommended diagnostic algorithm for the investigation of Hymenoptera venom allergic patients. a Insect honeybee (as reported by the patient), b Insect yellow jacket (as reported by the patient), and c Insect not identified by the patient
See this image and copyright information in PMC

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