Wilma C. Light

Unusual reactions following insect stings: Clinical features and immunologic analysis

Fifteen patients were studied who had unusual reactions following insect stings. These included serum sickness, neurologic disease, renal disease, and delayed hypersensitivity-type reactions. The clinical features are briefly outlined. Measurements were made of serum venom-specific IgE and IgG antibodies. These antibodies were present in some patients and in these instances suggested an immunologic pathogenesis for the reactions. Alternative etiologies for the unusual reactions are also discussed.

Clinical and immunological studies of beekeepers

Thirty‐four beekeepers were interviewed and their blood assayed for the presence of antibodies reacting with bee venom, bee venom phospholipase A (PLA), and whole bee body extract. Following a bee sting, most beekeepers experienced only minimal local tissue reaction. Their serum contained high levels of total antibodies (primarily IgG) reacting to bee venom and phospholipase A. These antibody titres correlated with the frequency of bee stings.

Comparison of the allergenic properties of bee venom and whole bee body extract

The allergenic properties of bee venom and whole bee body extract were compared by in vivo and in vitro tests. The majority of patients with known bee sting sensitivity had positive intracutaneous skin test reactions with bee venom and had bee venom specific IgE in their sera. Of seventeen patients with positive bee venom skin tests, nine had positive tests with whole bee body extract. Of thirty sera containing elevated levels of bee venom specific IgE obtained from untreated patients, fourteen sera contained whole body specific IgE but in much lower titres.

Immunological studies of the effect of whole body insect extracts in the treatment of stinging insect allergy.

Specific IgE antibodies and total antibodies reacting with bee venom and yellow jacket venom were measured in sequential serum samples of insect-sensitive individuals. Venom-specific IgE decreased as a function of time and was not significantly affected by treatment with whole body extracts. There was no stimulation of total antibodies reacting with bee venom phospholipase A2 (PLA) following treatment with whole bee body extracts. These studies suggest that as measured by these parameters, whole body insect extracts used in the usual recommended doses are immunologically ineffective antigens.

Stinging insect allergy: changing concepts.

Immunologic advances promise changes in the approach to diagnosis and treatment of Hymenoptera stings. Results of skin tests with venom show good correlation with those of in vitro tests (histamine release and radio-allergosorbent test [RAST]). Similar comparisons of whole-body extract (WBE) skin tests with in vitro tests show poor correlation. Treatment emphasis must currently be placed on sting prevention and on medical treatment. The only material now available commercially for immunotherapy is WBE. Circumstantial evidence suggests some benefit from immunotherapy with WBE, but immunologic data do not support this observation.

Asthma screening among inner city youth and high school athletes

Abstract Rationale Exercise challenges were used to determine the incidence of asthma among inner city youth and high school athletes. Methods Consent forms and a 10-item screening questionnaire were obtained prior to the exercise challenge. Free running was performed indoors or outdoors depending on the sport. The heart rate increased to 140 to 160/minute post-run. FEV 1 and PEFR were measured at intervals of 5 to 30 minutes post-run. Letters were sent to parents to request follow-up for those with abnormal results. Results 49 of 127 (38%) children from ages 6 to 18 years of age showed a 15% or more drop in the FEV 1 post-run. 7 of 51 (14%) who had abnormal results were known asthmatics with prescribed medications. The PEFR did not always correspond to the FEV 1 results. A positive family history of asthma and/or allergies was the most common pre-screen answer for those at risk. Letters to the parents were not effective in having the children seen in follow-up. Conclusions A large number of inner city youth and high school athletes have undiagnosed asthma. Some of those diagnosed with asthma were unable to successfully complete the exercise challenge. Follow-up among those who failed the challenge was poor. Our results suggest that school officials such as coaches or trainers may improve follow-up.