R.E. Reisman

Venom immunotherapy: 10 years of experience with administration of single venoms and 50 μg maintenance doses

Abstract For the past 10 years, we have administered venom immunotherapy with single venoms, whenever it is possible, and maintenance doses of 50 μg. The choice of venoms was based on clinical history, skin test reactions, and a knowledge of venom cross-reactivity. There have been. 258 re-stings in 108 patients with only three systemic reactions (2.7% per patient; 1.2% per sting). Two of these re-stings reactions were very mild, hives and facial edema, in patients who had had initial severe anaphylaxis. Five other patients had transient ill-defined symptoms, not considered allergic after re-stings. The patients covered a wide age range. Twenty-seven patients, nine under age 16 years, had initial dermal reactions only, and 44 patients had severe anaphylaxis. Most patients had multiple positive skin tests. Seventy-five patients received single venoms (yellow.jacket, 58; honeybee, 15; hornet, 2), and 30 patients received two venoms. Re-stings occurred from 1 month to 8 years, (mean, 2 years) after starting treatment. Results indicate that this approach with 50 μg top doses and single venom immunotherapy may be sufficient in most patients with an associated decrease in the cost as well as possible increased morbidity associated with the use of multiple venom antigens.

Clinical and immunologic studies of patients with large local reactions following insect stings

During the summer of 1978, 22 patients who had large local reactions following insect stings were evaluated for the development of potential systemic sensitivity. Approximately half the patients had venom IgE antibodies, detected by either the immediate skin test or radioallergosorbent test (RAST). A control group of 26 patients experiencing normal sting reactions had only a 15% incidence of venom-specific IgE. No correlations could be found between the presence of venom-specific IgE and age, sex, sting location, atopic history, or prior stings. IgE antibodies were found in 13 of 17 patients who had experienced local reactions lasting more than 48 hr. Serum venom-specific IgG was detected in only three of 19 patients. These results suggest that following large local reactions from insect stings patients must be individually assessed for the presence of venom-specific IgE and consideration for specific immunotherapy.

Analysis of differing patterns of cross-reactivity of honeybee and yellow jacket venom-specific IgE: use of purified venom fractions

Prior studies of sera from insect sting-allergic patients have analyzed the relationship of coexisting honeybee venom- and yellow jacket venom-specific IgE. Radioallergosorbent (RAST)-inhibition tests with these venoms revealed four different patterns of activity. In this present study, purified fractions prepared from these venoms were used to analyze these varying patterns. The hyaluronidases of yellow jacket venom and honeybee venom showed extensive cross-reaction. The phospholipases from these venoms showed minimal cross-reactivity; antigen 5 was restricted to yellow jacket venom. There was a high molecular weight component in yellow jacket venom with immunologic properties similar to honeybee venom acid phosphatase. Sera from individual patients showed quantitative and qualitative differences in the reactions to the major components of both venoms. The differences in the RAST-inhibition patterns in patients with elevated levels of both honeybee venom- and yellow jacket venom-specific IgE are accounted for by these differences as well as by differences in the cross-reactivity between the individual components.

Allergenic Components of Bald-Faced Hornet (V. maculata) Venom

Bald-faced hornet (V. maculata) venom collected by electrical stimulation was fractionated using molecular exclusion gel-filtration and ion-exchange chromatography. Four fractions w

In vitro Reaction of Antibodies to Ragwed

A radioimmunoassay was developed in which human antibodies to ragweed compete with 12Ι-labeled rabbit anti-ragweed antibodies for the ragweed antigen coupled to cellulose particles. By mean

Insect Allergy: Stinging and Biting Insects

Allergic reactions due to the common stinging insects bee, wasp, yellow jacket, and hornet will be the primary emphasis of this chapter. In addition, reactions due to fire ants, which are nonwinged hymenoptera, and biting insects will be briefly considered.