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Clinical Aspects of Hymenoptera Allergy: IgE Response, Stings, and Immunotherapy

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Abstract

Venom allergy evaluation is an important part of the allergist’s practice. There are a variety of clinical reactions to Hymenoptera stings including local reactions, large local reactions, systemic reactions, toxic reactions, and unusual reactions. Mastocytosis is an important risk factor for systemic reactions, and antihypertensive medications may increase the severity of systemic reactions. Susceptible individuals mount a Th2 immune response leading to IgE production. T regulatory cell responses then guide the immune system toward tolerance or an allergic response. It is clinically important to distinguish between sensitization and allergy, as sensitization can be high in insect-endemic regions (particularly imported fire ant). Immunotherapy has advanced for flying Hymenoptera from whole body extracts to standardized venom. Practical considerations and clinical effectiveness have kept treatment of imported fire ant patients to whole body extracts. Protocols have been developed to safely administer venom immunotherapy in a rapid manner, through “cluster” or “rush” protocols which are discussed. Once maintenance immunotherapy is tolerated, in some cases, the interval can be spaced to 3 months. Immunotherapy side effects and adjuncts (such as omalizumab) are reviewed.

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  1. Department of Allergy, US Air Force, RAF Lakenheath, Brandon, UK

    Kevin M. White M.D.

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  1. San Antonio Allergy and Asthma Clinic, San Antonio, Texas, USA

    Theodore M. Freeman

  2. Allergy, Asthma & Immunology Associates P.C., Omaha, Nebraska, USA

    James M. Tracy

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White, K.M. (2017). Clinical Aspects of Hymenoptera Allergy: IgE Response, Stings, and Immunotherapy. In: Freeman, T., Tracy, J. (eds) Stinging Insect Allergy. Springer, Cham. https://doi.org/10.1007/978-3-319-46192-2_4

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