Added sensitivity of component-resolved diagnosis in hymenoptera venom-allergic patients with elevated serum tryptase and/or mastocytosis

Allergy. 2016 May;71(5):651-60. doi: 10.1111/all.12850. Epub 2016 Feb 23.

Abstract

Background: Anaphylaxis caused by hymenoptera venom allergy is associated with elevation of baseline serum tryptase (sBT) and/or mastocytosis in about 5% of patients. Up to now, no information has become available on single venom allergen sIgE reactivity and the usefulness of component-resolved approaches to diagnose this high-risk patient group. To address the component-resolved sIgE sensitization pattern and diagnostic sensitivity in hymenoptera venom-allergic patients with elevated sBT levels and/or mastocytosis, a panel of yellow jacket and honeybee venom allergens was applied on a widely used IgE immunoassay platform.

Methods: Fifty-three patients with mastocytosis and/or elevated sBT tryptase level and systemic reactions to hymenoptera venoms were analyzed for their IgE reactivity to recombinant yellow jacket and honeybee venom allergens by Immulite3 g.

Results: sIgE reactivity to Ves v 1, Ves v 5, Api m 1 to Api m 4 and Api m 10 was found at a similar frequency in hymenoptera venom-allergic patients with and without elevated sBT levels and/or mastocytosis. However, the use of the recombinant allergens and a diagnostic cutoff of 0.1 kUA /L allowed the diagnosis of patients with otherwise undetectable IgE to venom extract. The diagnostic sensitivity of yellow jacket venom allergy using the combination of Ves v 1 and Ves v 5 was 100%.

Conclusions: In high-risk patients with elevated sBT levels and/or mastocytosis, the use of molecular components and decreasing the threshold sIgE level to 0.1 kUA /L may be needed to avoid otherwise undetectable IgE to hymenoptera venom extracts in about 8% of such patients.

Keywords: component-resolved diagnosis; diagnostic sensitivity; hymenoptera venom allergy; mastocytosis; serum tryptase.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Allergens / immunology
  • Anaphylaxis / blood*
  • Anaphylaxis / diagnosis*
  • Anaphylaxis / etiology*
  • Animals
  • Antibody Specificity / immunology
  • Arthropod Venoms / immunology*
  • Biomarkers
  • Female
  • Humans
  • Hymenoptera / immunology*
  • Immunoglobulin E / blood
  • Immunoglobulin E / immunology
  • Male
  • Mastocytosis / blood*
  • Mastocytosis / diagnosis
  • Middle Aged
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Tryptases / blood*
  • Young Adult

Substances

  • Allergens
  • Arthropod Venoms
  • Biomarkers
  • Immunoglobulin E
  • Tryptases