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Immunological and clinical factors associated with adverse systemic reactions during the build‐up phase of honeybee venom immunotherapy
Author(s) -
Korošec P.,
Žiberna K.,
Šilar M.,
Dežman M.,
Čelesnik Smodiš N.,
Rijavec M.,
Kopač P.,
Eržen R.,
Lalek N.,
Bajrović N.,
Košnik M.,
Zidarn M.
Publication year - 2015
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1111/cea.12582
Subject(s) - medicine , sting , basophil activation , anaphylaxis , adverse effect , allergy , tryptase , immunology , venom , cd63 , allergen , basophil , immunoglobulin e , mast cell , antibody , biology , ecology , microrna , biochemistry , microvesicles , gene , engineering , aerospace engineering
Summary Background Adverse systemic reactions ( SR s) are more common in honeybee venom immunotherapy ( VIT ) than in wasp VIT . Factors that might be associated with SR s during the honeybee VIT are poorly understood. Objective Our aim was to evaluate risk factors for SR s during the build‐up phase of honeybee venom immunotherapy. Methods We included 93 patients who underwent ultra‐rush honeybee VIT . The adverse SR s and their severity was compared to various immunological ( sIgE , tIgE , basophil CD 63 response, baseline tryptase, and skin tests), patient‐specific (age, sex, cardiovascular conditions and medications, and other allergic diseases), and sting‐specific factors (anaphylaxis severity, time interval to onset of symptoms, and absence of cutaneous symptoms). Results Twenty‐three patients (24.7%) experienced mild SR s and 13 patients (14%) severe SR s. In five patients with severe SR s, the build‐up was stopped. High basophil allergen sensitivity, evaluated as dose–response curve metrics of EC 15, EC 50, CD ‐sens, AUC , or the response to submaximal 0.01 μg/mL of venom concentration, was the most significant risk factor and only independent predictor of severe SR s and/or build‐up stop. Time interval of <5 min after sting to onset of symptoms and lower specific IgEs to rA pi m1 was also associated with severe SR s. There was no difference in other immunological, patient‐specific, or sting‐specific factors, including the baseline tryptase. None of the studied factors was associated with mild SR s. Conclusion and Clinical Relevance High basophil allergen CD 63 sensitivity phenotype was a major indicator of severe adverse SR s during the build‐up phase of honeybee VIT . Possibly role was also showed for short latency to filed sting reaction and low sIgE to rA pi m1. Before honeybee VIT , measurement of basophil allergen sensitivity should be used to identify patients with a high risk for severe side‐effects.