Diagnosis and treatment of allergy to hymenoptera venoms

This review overviews select advances reported in the literature from mid-2008 to the present in the diagnosis and management of individuals with immediate-type hypersensitivity to hymenoptera venom(s).

Skin testing remains the principal confirmatory test for sensitization to hymenoptera venoms. Use of dialyzed extracts in North America could enhance the sensitivity of intradermal skin testing. Hymenoptera venom components are overviewed with focus on their use in IgE antibody microarray assays to distinguish true dual sensitization to yellow jacket venom (YJV) and honeybee venom (HBV) proteins from carbohydrate-related cross-reactivity. Mechanisms on how venom induces vascular permeability in the skin following intradermal testing are elucidated and how tolerance is induced following high-dose venom exposure. For management, venom immunotherapy remains the most effective treatment. Use of immunotherapy in large local reactors to reduce morbidity is discussed. Baseline serum tryptase levels have been identified as one potential marker for severe systemic reactions to a subsequent sting.

Minor enhancements involving dialyzed venoms, component allergens, and microarray systems are poised to improve diagnostic confirmatory assays. Use of venom immunotherapy in large local reactors and tryptase as a predictor of a future severe venom-induced systemic reaction may enhance management programs for stinging insect allergic individuals.