[Cross reactions between Hymenoptera venoms from different families, genera and species]

Simultaneous reactivity with the venoms of different Hymenoptera is commonly seen in patients allergic to insect venoms. Strong, though individually variable, cross-reactivity occurs between the venoms of different Vespinae species (Vespula, Dolichovespula, Vespa). In Middle Europe, anaphylaxis after European hornet stings is nearly always due to cross-reactivity with Vespula venom. The identification of the primary venom in patients testing positive for Vespula and Polistes (paper wasps) is particularly important in Mediterranean areas. Component-resolved diagnosis with the marker allergens Ves v 5 and Pol d 5 may directly identify the causative venom in the majority of patients. There is substantial cross-reactivity between honeybee and bumblebee venom, sometimes causing allergic symptoms in patients allergic to honeybee venom after accidental bumblebee stings. However, subjects strongly exposed to bumblebees may show bumblebee-specific sensitization and require immunotherapy with bumblebee venom. More than half of all venom-allergic patients show double-positive test results to honeybee and vespid venoms. This may be due to true double sensitization or due to cross-reactivity between homologous allergens present in both venoms and sharing around 50 % sequence identity, i.e. hyaluronidases (Api m 2/Ves v 2), dipeptidyl peptidases (Api m 5/Ves v 3), and vitellogenins (Api m 12/Ves v 6). The clinical relevance of these cross-reactions is unknown. In up to 50 % the double-positivity is caused by clinically irrelevant IgE antibodies against CCDs. Many (though not all) patients with true double sensitization may be identified by means of the species-specific marker allergens Api m 1 and Ves v 1/5. Some Vespula venom-allergic patients may clinically cross-react to fire ant stings (Solenopsis), but otherwise allergen relationships with other ant species are not well studied.