IgE-Api m 4 Is Useful for Identifying a Particular Phenotype of Bee Venom Allergy.
BACKGROUND AND OBJECTIVE
Different clinical behaviors have been identified in patients allergic to bee venom. Compound-resolved diagnosis could be an appropriate tool for investigating these differences. The aims of this study were to analyze whether specific IgE to Api m 4 (sIgE-Api m 4) can identify a particular kind of bee venom allergy and to describe response to bee venom immunotherapy (bVIT).


METHODS
Prospective study of 31 patients allergic to bee venom who were assigned to phenotype group A (sIgE-Api m 4 <0.98 kU/L), treated with native aqueous (NA) extract, or phenotype group B (sIgE-Api m 4 ≥0.98 kU/L), treated with purified aqueous (PA) extract. Sex, age, cardiovascular risk, severity of preceding sting reaction, exposure to beekeeping, and immunological data (intradermal test, sIgE/sIgG4-Apis-nApi m 1, and sIgE-rApi m 2-Api m 4 were analyzed. Systemic reactions (SRs) during bVIT build-up were analyzed. Immunological and sting challenge outcomes were evaluated in each group after 1 and 2 years of bVIT.


RESULTS
Phenotype B patients had more severe reactions (P=.049) and higher skin sensitivity (P=.011), baseline sIgE-Apis (P=.0004), sIgE-nApi m 1 (P=.0004), and sIgG4-Apis (P=.027) than phenotype A patients. Furthermore, 41% of patients in group B experienced SRs during the build-up phase with NA; the sting challenge success rate in this group was 82%. There were no significant reductions in serial intradermal test results, but an intense reduction in sIgE-nApi m 1 (P=.013) and sIgE-Api m 4 (P=.004) was observed after the first year of bVIT.


CONCLUSION
Use of IgE-Api m 4 as the only discrimination criterion demonstrated differences in bee venom allergy. Further investigation with larger populations is necessary.
['Ruiz|B|B|', 'Serrano|P|P|', 'Moreno|C|C|']
D000328:Adult D000368:Aged D000485:Allergens D000707:Anaphylaxis D000818:Animals D001514:Bee Venoms D001516:Bees D015415:Biomarkers D003888:Desensitization, Immunologic D005260:Female D006801:Humans D007073:Immunoglobulin E D007299:Insect Bites and Stings D019476:Insect Proteins D008137:Longitudinal Studies D008297:Male D008875:Middle Aged D010641:Phenotype D011237:Predictive Value of Tests D011379:Prognosis D011446:Prospective Studies D012698:Serologic Tests D012720:Severity of Illness Index
Bee venom immunotherapy Sting challenge Bee venom allergens Component-resolved diagnosis Systemic reaction.