Combined active and passive immunotherapy in honeybee-sting allergy

Area of Science:

• Allergy and Immunology
• Immunotherapy
• Toxicology

Background:

• Bee venom immunotherapy (VIT) is a treatment for honeybee sting allergies.
• Previous attempts at VIT were halted due to recurrent allergic side effects (SE).
• Passive immunotherapy using beekeeper gammaglobulin was explored to improve VIT tolerance.

Purpose of the Study:

• To evaluate the efficacy of beekeeper gammaglobulin pretreatment in patients with honeybee sting allergy previously intolerant to VIT.
• To assess the impact of passive immunotherapy on the dose escalation and maintenance of bee venom immunotherapy.
• To investigate the qualitative aspects of the patients' IgG response to bee venom components.

Main Methods:

• Five patients with a history of severe allergic side effects to bee venom immunotherapy (VIT) received pretreatment with beekeeper gammaglobulin.
• Rush hyposensitization protocol was used to increase the tolerated dose of honeybee venom (BV).
• Immunological analysis, including crossed radioimmunoelectrophoresis and IgG subclass analysis, was performed.

Main Results:

• Pretreatment with beekeeper gammaglobulin allowed a 5- to 800-fold increase in tolerated bee venom dose, with maintenance doses reached rapidly.
• The IgG response to bee venom was not suppressed by the gammaglobulin infusion.
• Allergic side effects recurred in all patients within 2 to 9 weeks, necessitating dose adjustments or discontinuation in one case.
• Analysis revealed a lack of IgG response to specific bee venom components in some patients and an atypical IgG subclass pattern compared to tolerant beekeepers (lacking IgG2 response).

Conclusions:

• Beekeeper gammaglobulin can facilitate dose escalation in bee venom immunotherapy for allergic patients.
• The recurrence of side effects suggests that passive immunotherapy does not fully resolve underlying immune system deficiencies.
• Qualitative defects in the patients' endogenous IgG response, particularly the absence of an IgG2 response, may contribute to treatment failure in bee venom immunotherapy.