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Insect sting allergy …

Insect sting allergy

Presented by Chuleeporn Kongmeesook, MD,

2013

Published in Health & Medicine
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  • 1. INSECT ALLERGY CHULEEPORN KONGMEESOOK ,MD
  • 2. Outline Epidemiology Clinical presentations Diagnosis Treatment
  • 3. Apidae Vespidae Formocidae Pesek et al. Allergy Asthma Immunol Res. 2013 May;5(3):129-137. May;5 ):129-137. Bilό et al. Allergy 2005;60: 1339–1349. Bilό 2005;60: 1339–1349.
  • 4. Apidae
  • 5. Vespidae
  • 6. Formicidae
  • 7. Pesek et al. Allergy Asthma Immunol Res. 2013 May;5(3):129-137. May;5 ):129-137. Bilό et al. Allergy 2005; 60: 1339–1349. Bilό 2005; 60: 1339–1349.
  • 8. Cross reactivity 1 Double or even multiple positive tests can be caused by true double sensitization or by cross-reactive crossIgE antibodies. Bilό et al. Allergy 2005; 60: 1339–1349 Bilό 2005; 60: 1339–
  • 9. Cross reactivity 2 Within Apidae family Venoms and major allergens of different honeybees worldwide very similar (Phospholipase A2). Bumblebee PLA2 is only 53%. PLA2 53%. Immunologic cross-reactivity exist between crosshoneybee and bumblebee venoms venoms. Bilό et al. Allergy 2005; 60: 1339–1349 Bilό 2005; 60: 1339–
  • 10. Cross reactivity 3 Within vespid venoms CrossCross-reactivity among vespids is strong, due to similarities of venom composition and structure of single allergens. Bilό et al. Allergy 2005; 60: 1339–1349 Bilό 2005; 60: 1339–
  • 11. Cross reactivity 4 Between venoms of Apidae and Vespidae Hyaluronidase (major crossreactive component) 50% sequence identity between component) 50% honeybee and vespid venoms Bilό et al. Allergy 2005; 60: 1339–1349 Bilό 2005; 60: 1339–
  • 12. Epidemiology 1 Depending on country’s climate. 56. 56.6 – 94.5% stung by Hymenoptera insect 94. at least once in live. Prevalence 9.3 - 28.7% in adult. 28. Bilό et al. Allergy and Clinical Immunology 2008 ; 8:330–337 Bilό 330–
  • 13. Epidemiology 2 Systemic allergic reactions up to 3% of adults and 1% of children. Large local reactions uncertain, estimated 10% 10% in adults. Fatal stings at least 40 each year in USA and 16– 16–38 in France. Lieberman P In: Allergy: Principles and Practice. Elsevier Inc, 2009. p. 1005-17 2009. 1005-
  • 14. Epidemiology in Thailand 1 Chulalongkorn Etiologies of anaphylaxis : Drug 48 %, Food 31 %, Contrast media 6 %, Unknown 5 % and Insect sting 4 %. Techapornroong M et al Asian Pac J Allergy Immunol 2010;28:262-9. 2010;28:262-
  • 15. Epidemiology in Thailand 2 Siriraj Causes of Anaphylaxis : Drugs 50 %, Foods 24 %, Idiopathic 15 % and Insect stings/bites 11 %. Jirapongsananuruk O et al Ann Allergy Asthma Immunol. 2007;98:157–162. 2007;98:157–162.
  • 16. Epidemiology in Thailand 3 Thammasat Causes of Anaphylaxis : Foods 40 %, Drugs 36 %, Unidentified 17 % and Hymenoptera 5 %. Poachanukoon O et al ASIAN PACIFIC JOURNAL OF ALLERGY AND IMMUNOLOGY 2006; 24:111-116 . 2006; 24:111-
  • 17. เดลิ นิวส์ 24 เมษายน 2556
  • 18. Clinical presentations Local reaction Large local reaction Systemic reaction Unusual reaction Lieberman P In: Allergy: Principles and Practice. Elsevier Inc, 2009. p. 1005-17 2009. 1005-
  • 19. Risk factors of Hymenoptera venom allergy Time interval between stings, number of stings Venom sensitization Severity of preceding reaction Age Cardiovascular diseases, b-blockers bInsect Elevated serum tryptase, mastocytosis tryptase, M. T. Krishna et al Clinical & Experimental Allergy 2011 ;41:1201–1220. 41:1201–1220. Bilό et al. Clinical & Experimental Allergy 2009 ;39: 1467–1476 Bilό 39: 1467– Bilό et al. Allergy 2005; 60: 1339–1349 Bilό 2005; 60: 1339–
  • 20. Diagnosis Clinical history Skin tests In vitro tests Sting challenge test Lieberman P In: Allergy: Principles and Practice. Elsevier Inc, 2009. p. 1005-17 2009. 1005-
  • 21. Treatment of acute reactions www.eaaci.net
  • 22. Preventing insect stings www.cdc.gov
  • 23. Preventing fire ant stings and bites www.cdc.gov
  • 24. Venom immunotherapy 1 Indication History of previous systemic reaction to a sting and evidence of venom-specific IgE venomantibodies. Goal Prevent systemic reactions. Alleviate patients’ anxiety related to insect stings. GOLDEN ET AL J ALLERGY CLIN IMMUNOL 2011 ;127:852-4 127:852Lieberman P In: Allergy: Principles and Practice. Elsevier Inc, 2009. p. 1005-17 2009. 1005-
  • 25. www.eaaci.net
  • 26. Bovie RJ et al. The Cochrane Collaboration 2012 ;1-70. 70.
  • 27. Valentine et al. N Engl J Med 1990;323:1601-3. 1990;323:1601-
  • 28. David B.K. Golden et al N Engl J Med 2004;351:668-74. 2004;351:668-74.
  • 29. Venom immunotherapy 2 Selection of venom in honey bee and bumblebee Marked cross-reactivity. crossHoneybee venom alone will be sufficient. Bonifazi et al. Allergy 2005; 60: 1459–1470 2005; 60: 1459–
  • 30. Venom immunotherapy 3 Selection of venom in vespids CrossCross-reactivity exists between major venom components of several vespids. vespids. Most common therapy for vespid sensitivity is mixed vespid venoms. Lieberman P In: Allergy: Principles and Practice. Elsevier Inc, 2009. p. 1005-17 2009. 1005Bonifazi et al. Allergy 2005; 60: 1459–1470 2005; 60: 1459–
  • 31. Venom immunotherapy 4 Selection of venom in Apidae and Vespidae CrossCross-reactivity very limited limited. Treatment with both venoms only indicated in double sensitization. Bonifazi et al. Allergy 2005; 60: 1459–1470 2005; 60: 1459–
  • 32. Venom immunotherapy 5 Duration of venom immunotherapy Should continued at least 3 - 5 years. Some patients need to continue for extended period of time or indefinitely. GOLDEN ET AL J ALLERGY CLIN IMMUNOL 2011 ;127:852-4 127:852-
  • 33. GOLDEN ET AL J Allergy Clin Immunol 2000;105:385-90 2000;105:385-
  • 34. Venom immunotherapy 6 Efficacy 95–100% 95–100% effective in preventing systemic reactions to stings. 100 µg dose of individual venoms (honeybee, yellow jacket or Polistes wasp) have 75–95% efficacy. 75–95% efficacy. Lieberman P In: Allergy: Principles and Practice. Elsevier Inc, 2009. p. 1005-17 2009. 1005-
  • 35. Venom immunotherapy 7 Safety Systemic symptoms occur in 5–15% during 15% initial weeks of treatment. Pretreatment with antihistamines reduce local and systemic reactions, and may reduce frequency of systemic reactions. Lieberman P In: Allergy: Principles and Practice. Elsevier Inc, 2009. p. 1005-17 2009. 1005-
  • 36. Venom immunotherapy 8 Treatment protocol Traditional regimen Modified rush Rush regimen UltraUltra-rush regiment Lieberman P In: Allergy: Principles and Practice. Elsevier Inc, 2009. p. 1005-17 2009. 1005-
  • 37. GOLDEN ET AL J ALLERGY CLIN IMMUNOL 2011 ;127:852-4 127:852-
  • 38. GOLDEN ET AL J ALLERGY CLIN IMMUNOL 2011 ;127:852-4 127:852-
  • 39. GOLDEN ET AL J ALLERGY CLIN IMMUNOL 2011 ;127:852-4 127:852-
  • 40. GOLDEN ET AL J ALLERGY CLIN IMMUNOL 2011 ;127:852-4 127:852-
  • 41. S.C. Stokes et al. Ann Allergy Asthma Immunol 2013;110 :165 -167 2013;
  • 42. S.C. Stokes et al. Ann Allergy Asthma Immunol 2013;110 :165 -167 2013;
  • 43. S.C. Stokes et al. Ann Allergy Asthma Immunol 2013;110 :165 -167 2013;
  • 44. S.C. Stokes et al. Ann Allergy Asthma Immunol 2013;110 :165 -167 2013;
  • 45. GOLDEN ET AL J ALLERGY CLIN IMMUNOL 2011 ;127:852-4 127:852-
  • 46. GOLDEN ET AL J ALLERGY CLIN IMMUNOL 2011 ;127:852-4 127:852-
  • 47. GOLDEN ET AL J ALLERGY CLIN IMMUNOL 2011 ;127:852-4 127:852-
  • 48. Take Home Message Systemic reaction from insect sting and venom-specific IgE antibodies should venomreceive VIT. VIT should continue for at least 3-5 yrs.
  • 49. THANK YOU