Component-resolved diagnosis in selecting patients for yellowjacket venom immunotherapy

Area of Science:

• Allergen immunotherapy
• Clinical immunology
• Diagnostic testing

Background:

• Venom immunotherapy effectively prevents systemic allergic reactions (SARs).
• Accurate diagnosis of venom allergy remains a significant clinical challenge.
• Component-resolved diagnosis (CRD) and conventional tests require performance comparison.

Purpose of the Study:

• To compare the diagnostic performance of CRD and conventional tests in patients undergoing venom immunotherapy.
• To evaluate the accuracy of various serological and skin tests for venom allergy diagnosis.

Main Methods:

• Serum-specific immunoglobulin E (sIgE) to yellowjacket (Ves v 1, Ves v 5) and honeybee (Api m 1) venoms were measured.
• Cross-reactive carbohydrate determinants (CCDs), serum basal tryptase, and skin prick tests (SPTs) were assessed.
• Patient history of SAR and its severity were evaluated in 84 referred patients.

Main Results:

• Specific IgE to yellowjacket whole-venom extract spiked with Ves v 5 (AUC 0.87) and Ves v 5 alone (AUC 0.86) were most accurate in confirming allergy after SAR.
• Ves v 1 sensitization was infrequent (AUC 0.62).
• YJV SPT sensitivity was 86% but specificity was low (54%); frequent cross-sensitization observed.

Conclusions:

• Specific IgE to yellowjacket venom spiked with Ves v 5 accurately confirms venom allergy post-SAR.
• Confirming a history of SAR is crucial before diagnostic testing.
• Venom sensitization is common in patients with non-SAR reactions, necessitating careful interpretation.