Which immunotherapy product is better for patients allergic to Polistes venom? A laboratory and clinical study

• Published in: PloS one Vol. 12; no. 7; p. e0180270
• Main Authors: Savi, Eleonora, Incorvaia, Cristoforo, Boni, Elisa, Mauro, Marina, Peveri, Silvia, Pravettoni, Valerio, Quercia, Oliviero, Reccardini, Federico, Montagni, Marcello, Pessina, Laura, Ridolo, Erminia
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.07.2017; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Aged; Allergens - administration & dosage; Allergens - chemistry; Allergens - immunology; Allergic reactions; Allergies; Allergy; Animals; Antigens; Bees; Biology and Life Sciences; Care and treatment; Clinical trials; Desensitization, Immunologic - methods; Europe; Food allergies; Humans; Hypersensitivity; Hypersensitivity, Immediate - immunology; Hypersensitivity, Immediate - physiopathology; Hypersensitivity, Immediate - therapy; Immunoglobulin E; Immunoglobulin E - blood; Immunology; Immunotherapy; In vitro methods and tests; Inhibition; Insect bites; Insect Bites and Stings - immunology; Insect Bites and Stings - physiopathology; Insect Bites and Stings - therapy; Insects; Medicine and Health Sciences; Middle Aged; Patients; Polistes dominula; Reliability analysis; Silicon germanides; Species Specificity; Stings; Stings (Injuries); United States; Venom; Venoms; Wasp Venoms - administration & dosage; Wasp Venoms - chemistry; Wasp Venoms - immunology; Wasps - chemistry; Wasps - immunology
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0180270

Venom immunotherapy (VIT) is highly effective in preventing allergic reactions to insect stings, but the appropriate venom must be used to achieve clinical protection. In patients with multiple positive results to venoms, molecular allergy diagnostics or CAP-inhibition may identify the causative venom. Concerning allergy to venom from Polistes spp. it has been proposed that only the European species P. dominulus should be used for VIT. However, this recommendation is not present in any international guideline. Using both laboratory and clinical data, we aimed to evaluate the reliability of this proposal. We performed an in vitro study using CAP-inhibition to determine sensitization of 19 patients allergic to Polistes venom. The clinical study included 191 patients with positive tests to Polistes treated with VIT, 102 were treated with P. dominulus and 89 were treated with a mix of American Polistes (mAP). The difference in % of inhibition was significant concerning inhibition of P. dominulus sIgE by P. dominulus venom (79.8%) compared with inhibition by mAP venom (64.2%) and not significant concerning the inhibition of mAP sIgE by P. dominulus venom (80.1%) and by mAP venom (73.6%). Instead, the clinical protection from stings was not statistically different between the two kinds of venom. The data from CAP inhibition would suggest that the choice of either P. dominulus venom or mAP venom for VIT is appropriate in patients with CAP inhibition higher than 70%, but the clinical data show the same odds of protection from stings using for VIT P. dominulus or mAP venom.