PURPOSE: The basophil activation test (BAT) has been used to monitor venom immunotherapy (VIT) due to its high specificity. A previous study has reported a good correlation between a significant decrease in basophil activation during 5 years of VIT and clinical protection assessed by sting challenge. The following prospective study was performed to examine changes in basophil reactivity over a complete VIT period of 5 years. METHODS: BAT in a dose-response curve was studied prospectively in 10 hymenoptera venom-allergic patients over 5 years of VIT. BAT was performed at the time of diagnosis, 1 month after finishing the VIT build-up phase, and 3, 6, 12, 24, and 60 months after beginning treatment. The repeated measures ANOVA was applied to evaluate basophil activation changes throughout VIT. A cross-sectional study was also performed in 6 patients who received treatment for more than 3 years, and in another 12 patients who followed immunotherapy for at least 5 years. RESULTS: An early activation decrease was observed during the first 3 months of treatment, compared to pre-treatment values. This activation decrease was not maintained 6 to 18 months after treatment, but was observed again after 2 years of treatment, and maintained until the completion of the 5-year immunotherapy period. In cross-sectional analysis, the 6 patients who received treatment for 3 years, and 9 of the 12 patients who received treatment for 5 years, had negative BAT results. Three patients in this last group had positive BAT results and 2 patients had systemic reactions after field stings. CONCLUSIONS: BAT appears to be an optimal non-invasive test for close monitoring of VIT.
Basophils* ; Bites and Stings ; Cross-Sectional Studies ; Diagnosis ; Humans ; Hymenoptera ; Immunotherapy* ; Prospective Studies ; Sensitivity and Specificity ; Venoms*

Reactions to Hymenoptera stings are classified into local reactions, large local reactions, systemic anaphylactic reactions, systemic toxic reactions, and unusual reactions. They are also classified into immediate and delayed reactions. The most frequent clinical patterns are large local and systemic anaphylactic reactions. The skin, and the gastrointestinal, respiratory, and cardiovascular systems can be involved. A variety of unusual or unexpected reactions, such as acute encephalopathy, acute renal failure, nephrotic syndrome, silent myocardial infarction, diffuse alveolar hemorrhage, rhabdomyolysis, and cataracts, occur in a temporal relationship to insect stings. Here, we report a 31-year-old woman with delayed generalized edema, weight gain, and unusual reactions 24 hours after bee sting.
Acute Kidney Injury ; Adult ; Anaphylaxis ; Bees ; Bites and Stings* ; Brain Diseases ; Cardiovascular System ; Cataract ; Edema ; Female ; Hemorrhage ; Humans ; Hymenoptera* ; Insect Bites and Stings ; Myocardial Infarction ; Nephrotic Syndrome ; Rhabdomyolysis ; Skin ; Weight Gain

Hymenoptera stings can cause serious injury to humans. We report the clinical findings of 6 cases of Hymenoptera stings. All patients developed painful erythematous papules at the sting sites and had a past history of parasitoid wasp sting. This is the first clinical report of the parasitoid wasp, Cephalonomia gallicola, causing human stings in Korea.
Adult ; Animals ; Child, Preschool ; Female ; Gram-Positive Bacteria ; Humans ; Hymenoptera/*growth & development ; Insect Bites and Stings/*diagnosis/*pathology ; Male ; Middle Aged ; Republic of Korea

PURPOSE: We investigated the causes, clinical features, and risk factors of bee venom anaphylaxis in Korea. METHODS: The medical records of the diagnosis of anaphylaxis during a 5-year period from the 14 hospitals in Korea have been retrospectively reviewed. Cases of bee venom anaphylaxis were identified among anaphylaxis patients, and subgroup analyses were done. RESULTS: A total of 291 patients were included. The common cause of bee species was vespid (24.6%) in bee venom anaphylaxis, followed by honeybee and vespid (8.8%), apitherapy (7.7%), and honeybee (2.0%), although the causative bee species were commonly unknown (56.9%). The severity of anaphylaxis was mostly mild-moderate (72.9%), and common clinical manifestations included cutaneous (80.6%), cardiovascular (39.2%), respiratory (38.1%), and gastrointestinal (13.1%) symptoms. Portable epinephrine auto-injectors were prescribed to 12.1% of the patients. Subject positive to both vespid and honeybee showed more severe symptoms and higher epinephrine use (P<0.05). The severity was significantly associated with older age, but not with gender, underlying allergic disease, or family history. Apitherapy-induced anaphylaxis showed a higher rate of hospitalization and epinephrine use than bee sting anaphylaxis (P<0.05). CONCLUSION: Vespid is the most common cause of bee venom anaphylaxis in Korea. It is suggested that positivity to honeybee and vespid may be associated with more severe symptoms.
Adult* ; Anaphylaxis* ; Apitherapy ; Bee Venoms ; Bees ; Bites and Stings ; Diagnosis ; Epinephrine ; Hospitalization ; Humans ; Hymenoptera* ; Korea ; Medical Records ; Retrospective Studies* ; Risk Factors ; Venoms*

Reactions to Hymenoptera insect stings are common. While most are self-limited, some induce systemic allergic reactions or anaphylaxis. Prompt recognition, diagnosis, and treatment of these reactions are important for improving quality-of-life and reducing the risk of future sting reactions. This review summarizes the current recommendations to diagnose and treat Hymenoptera sting induced allergic reactions and highlights considerations for various populations throughout the world.
Anaphylaxis ; Bites and Stings ; Hymenoptera ; Hypersensitivity ; Insect Bites and Stings ; Insects

OBJECTIVE: To document the arthropod succession pattern and to identify forensically important species in northeastern Egypt (32° 15' E and 30° 36' N) for the first time. METHODS: Carcasses were exposed in an open area for 60 days during summer season. Ambient daily temperature (maximum and minimum) and relative humidity (RH) were recorded and existing keys were used for identification of different species. RESULTS: During the period of study, the mean of maximum and minimum temperatures were 34.85 °C and 29.2 °C respectively, while the mean of RH was 53.5%. Four stages of decomposition were observed: fresh, bloat, decay and dry. The most abundant orders were found to be Diptera, Coleoptera and Hymenoptera. Arthropods were collected belonging to 4 families of Diptera: Muscidae, Fanniidae, Calliphoridae and Sarcophagidae. While there were 2 families of Coleoptera: Dermestidae and Histeridae. Monomorium species was the only Hymenoptera family in this study. CONCLUSION The present work provided a basis for further studies dealing with insect colonization of carcasses in different seasons and locations in Egypt.
Animals ; Arthropods ; classification ; physiology ; Coleoptera ; Diptera ; Egypt ; Entomology ; Feeding Behavior ; Forensic Medicine ; methods ; Hymenoptera ; Insecta ; classification ; Rabbits ; Rats ; Seasons ; Temperature

In 1991, Kounis and Zavras described the "syndrome of allergic angina" as the coincidental occurrence of angina and allergic reactions by inflammatory mediators released during the allergic insult. Presently, both allergic angina and allergic myocardial infarction are referred to as "Kounis syndrome." Several allergens, including drugs, Hymenoptera venom, latex, food, and contrast media have been reported to trigger Kounis syndrome. Three variants of this syndrome have been described. Type I includes patients with normal coronary arteries, Type II includes patients with preexisting atheromatous disease where acute release of inflammatory mediators can induce coronary artery spasms, and Type III is associated with intracoronary thrombus formation caused by an allergic reaction. We report a case of Kounis syndrome who presented as acute myocardial infarction after intramuscular injection of a non-steroidal anti-inflammatory drug.
Allergens ; Anaphylaxis ; Contrast Media ; Coronary Vessels ; Humans ; Hymenoptera ; Hypersensitivity ; Injections, Intramuscular ; Latex ; Myocardial Infarction ; Spasm ; Thrombosis ; Venoms

PURPOSE: Although patient history is vital for the diagnosis of hymenoptera venom allergy, specific IgE detection is also important to identify the culprit insect and monitor the effect of immunotherapy. We evaluated the diagnostic value of serum-specific IgE detection of hymenoptera venom component allergens and documented changes in allergen-specific IgE after immunotherapy. METHODS: Fifty-six hymenoptera venom allergy patients receiving venom immunotherapy were recruited from Ajou University Hospital, Korea. The clinical manifestations of the patients were noted, and serum-specific IgE detection was performed, using conventional venom extracts as well as component allergens. Data were analyzed retrospectively. RESULTS: A total of 35 (62.5%) patients were male, and 33 (73.3%) patients were atopic. The mean patient age was 44.9+/-13.8 years. Localized reactions occurred in 23.2% of patients, and systemic reactions occurred in 76.8%. The most common clinical manifestations included skin involvement, such as urticaria and angioedema, and respiratory involvement. Yellow jackets were the most frequent culprit insect, followed by yellow hornets, white-faced hornets, honeybees, and paper wasps, as determined at the time of diagnosis. Double sensitization to both Apidae and Vespidae species was detected in 70.9% of patients. The positive predictive values (PPV) of rVes v 5-specific and rPol d 5-specific IgE detection were 85.7% and 87.5%, respectively, which correlated well with conventional venom extract-specific IgE detection (r=0.762 and r=0.757, respectively). In contrast, the PPV of rApi m 1-specific IgE detection at the time of diagnosis was 34.8%. Three years of venom immunotherapy resulted in decreased venom-specific IgE, particularly IgE specific for Vespidae venom components. CONCLUSIONS: Stings by yellow jackets and male sex may be risk factors for hymenoptera venom allergy in Korea. Vespidae component-specific IgE, but not Apidae component-specific IgE, had diagnostic and monitoring value in hymenoptera venom allergy comparable to that of conventional hymenoptera venom extract-specific IgE.
Allergens ; Angioedema ; Bees ; Bites and Stings ; Humans ; Hymenoptera ; Hypersensitivity ; Immunoglobulin E ; Immunotherapy ; Insects ; Korea ; Male ; Organothiophosphorus Compounds ; Risk Factors ; Skin ; Urticaria ; Venoms ; Wasps

BACKGROUND: Patients may receive negative results from a specific IgE (sIgE) test such as the ImmunoCAP (CAP) despite a documented history of systemic reaction to a Hymenoptera sting. Thus, further testing may be required using another serological method or venom skin prick tests to confirm allergy diagnosis and correct species. OBJECTIVE: To evaluate the sensitivity and the specificity of CAP and IMMULITE 3gAllergy (IMMULITE) for detecting sIgE to Paper wasp (WA) and Yellow Jacket (YJ) venoms using patient clinical history as the comparator. METHODS: Sera from 70 participants with a history of systemic reactions (SR) to WA and/or YJ stings were tested using CAP and IMMULITE. Fifty participants from this group had negative results on CAP. To assess specificity, sera from 71 participants who had never experienced either a WA or YJ sting were tested using CAP and IMMULITE. Fifty participants from this group tested positive using CAP. RESULTS: In participants with a history of systemic reaction to a Hymenoptera sting, yet who tested negative for WA and/or YJ sIgE according to CAP, the positivity rate according to IMMULITE was 20-42% using 0.10 IUA/mL as the limit of detection (LoD), per the manufacturer's specification. When the LoD for CAP (0.35 IUA/mL) was applied to the IMMULITE results, positivity according to IMMULITE was 14-26%. Overall, sensitivity, specificity, and agreement with SR were greater for IMMULITE than for CAP. For YJ: sensitivity (IMMULITE:CAP), 42.8%:28.5%; specificity, 53.5%:39.4%; agreement, 48.2%:34%. For WA, sensitivity (IMMULITE:CAP), 58.6%:28.5%; specificity, 49.3%:47.8%; agreement, 43.9%:38.3%. CONCLUSION: The IMMULITE performed well for detecting sIgE to Hymenoptera venom
Bites and Stings ; Diagnosis ; Humans ; Hymenoptera ; Hypersensitivity ; Immunoglobulin E ; Limit of Detection ; Methods ; Sensitivity and Specificity ; Skin ; Venoms ; Wasps

Apis mellifera L. bee venom is the most studied hymenoptera allergen, but many aspects of its action on human basophils remain unclear. Allergologists seek evidence of the effectiveness of bee venom immunotherapy as this approach is the chosen treatment for systemic allergic reactions. The effect of bee venom on human basophils in vitro has not been studied in detail for many reasons, including the paucity of basophils in peripheral blood, inter-individual basophil response variability, and the reliability and predictability of basophil activation tests. We conducted a brief preliminary survey of the effect of Apis bee venom on healthy asymptomatic (non-allergic) subjects. A dose of an aqueous commercial extract of Apis bee venom as high as 10 microg/mL activated resting basophils (CD63=+80-90%, CD203c=+30%), while it inhibited the expression of CD63 (-50%) following basophil stimulation by the soluble agonists formyl-Met-Leu-Phe or anti-IgE. The activation of resting basophils appeared to be dose-related. Only when basophils were activated with an IgE-mediated agonist, did bee venom extract exhibit a possible priming mechanism at the lowest doses used only via CD63, while it was ineffective via CD203c. Autocrine interleukin-3 may play a role in the observed biphasic behavior.
Antibodies, Anti-Idiotypic ; Basophils ; Bee Venoms ; Bees ; Blood Donors ; Flow Cytometry ; Honey ; Humans ; Hymenoptera ; Hypersensitivity ; Immunotherapy ; Interleukin-3